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A  lTEXT  book 

OF 

The  Principles  of  Osteopathy^ 


BY 


r 


Q^mjL. 


LETT,  B.  S.,  D.  0. 

Revised  at  the  request  of  the 
House  of  Delegates,  American  Osteopathic  Association, 

and  the 
Associated  Colleges  of  Osteopathy. 

C 
W 


FIFTH  EDITION 
1922 


Copyright  1922 
By  The  A.  T.  Still  Research  Institute 


My 


Preface  to  the  Fifth  Edition 


This  book  has  been  held  in  favor  by  members  of  the  osteopathic 
profession  for  twenty  years.  This  new  edition,  the  fifth,  has  been 
prepared  for  publication  at  the  request  of  the  American  Osteopathic 
Association  and  the  Associated  Colleges  of  Osteopathy.  The  follow- 
ing excerpt  from  the  preface  of  the  first  edition  indicates  the 
author's  viewpoint: 

"It  must  be  understood  at  the  outset  that  the  work  is  designed 
primarily  for  the  student  who  is  beginning  to  study  the  new  method 
of  healing.  Hence  to  those  who  are  already  practitioners  of  that 
method  the  matter  contained  in  the  following  pages  may  not  seem 
particularly  new  nor  satisfying  in  the  way  of  suggesting  ideas  of 
an  immediately  practical  nature.  Yet  we  are  not  without  hop^e 
that  even  to  the  latter  class  there  are  many  points  of  interest  which 
will  help  to  throw  light  upon  some  of  the  vexing  problems  that 
continually  arise  in  the  experience  of  the  busy  practitioner. 

''Neither  should  it  be  assumed  that  the  work  is  intended  to  treat 
exhaustively  the  numerous  questions  of  theory  that  are  associated 
with  the  science.  That  is  entirely  beyond  the  scope  of  a  work  that 
is  prepared  especially  for  him  who,  under  the  circumstances  of  a 
comprehensive  curriculum  of  study,  crowded  into  a  period  of  time 
all  too  short,  must  of  necessity  limit  his  reading  in  all  subjects  to 
those  texts  which  give  a  comparatively  brief  treatment.  This 
work,  th-erefore,  is  rather  a  mere  outline  of  the  various  subjects  that 
are  most  closely  related  to  the  fundamentals  of  the  science,  with 
suggestions  as  to  the  direction  further  investigation  should  take. 

"The  various  subjects  outlined  and  the  manner  of  their  treatment 
are  the  result  of  the  labor  of  the  author,  who  has  been  especially 
devoted  to  the  principles  of  osteopathy  during  his  course  as  teacher 
for  the  past  three  years.  In  large  part  the  work  here  presented  is 
a  revision  of  lectures  delivered  before  classes  in  Principles  of  Os- 
teopathy, ^ 

"The  work  is  divided  into  volumes  I  and  II,  indicating  a  differ- 
ence in  the  nature  and  arrangement  of  the  matter  treated.  This  dif- 
ference lies  in  the  more  general  nature  of  the  substance  of  volume  I, 

S      ' 


tlie  more  specific  in  volume  II.  Certain  fundamental  propositions 
bearing  on  the  general  problems  of  life,  health,  and  disease  ai«  dis- 
cussed in  the  former,  while  the  deductions  drawn  therefrom  are 
applied  specifically  in  the  latter  to  the  various  regions  of  the  body." 

Experience  has  justified  the  author's  method  in  using  the  nar- 
rative style.  In  the  book-making  the  aim  has  been  to  combine  con- 
venient size,  durable  and  attractive  binding,  and  paper  and  type 
comfortable  to  the  eye. 

In  part,  this  revision  has  been  based  upon  some  work  done  by 
Dr.  C.  M.  T.  Hulett  in  1915.  The  more  definite  work  has  been  done 
by  the  co-operation  of  the  Professors  of  Principles  of  Osteopathy 
in  the  osteopathic  colleges.  While  the  amount  of  work  done  varies, 
yet  some  help  has  been  given  by  each  of  the  colleges  named;  they 
are  arranged  in  alphabetical  order: 

American  School  of  Osteopathy, 

Kirksville,  Missouri 

A.  T.  Still  College  of  Osteopathy  and  Surgery, 

Kirksville,  Missouri 

Chicago  College  of  Osteopathy, 

Chicago,  Illinois 

College  of  Osteopathic  Physicians  and  Surgeons, 

Los  Angeles,  California 

Kansas  City  College  of  Osteopathy  and  Surgery, 

Kansas  City,  Missouri 

Massachusetts  College  of  Osteopathy, 

Boston,  Massachusetts 

Philadelphia  College  of  Osteopathy, 

Philadelphia,  Pennsylvania 

Education  Department, 

THE  A.  T.  STILL  RESEARCH  INSTITUTE. 

Louisa  Burns,  Dean. 

October  20,  1922. 


Contents 


CHAPTER  I— Introductory                                                            Page 
An  Art  and  a  Science 12 

CHAPTER  II— An  Evolution  and  a  Revolution 

Ancient  Practices 14 

Age  of  Hippocrates 14 

Galen   15 

The  Middle  Ages 16 

Modern  Times 17 

CHAPTER  III— The  Revolution 

Definitions   22 

CHAPTER  IV— Some  Fundamental  Considerations 

Viewpoint  of  Life 23 

CHAPTER  V— Structure  and  Function 

The  Cell  Doctrine 26 

CHAPTER  VI— Unity  of  the  Body 

CHAPTER  VII— Cause  of  Disease  Not  in  the  Cell 

Metabolism  34 

Circulation   35 

Structural   Causes 35 

CHAPTER  VIII— Man  a  Machine 

The  Body  a  Physical  Mechanism 37 

A  Chemical  Laboratory 38 

CHAPTER  IX— The  Energy  of  the  Body 

Nature  of  Energy ; 43 

Chemical  Action 44 

Molecular  Relations 45 

Gravitation  45 

Friction 46 

Heat  46 

Light 47 

Electricity  48 

Nerve  Energy 49 

Energy  Balance 49 

Balance  Sheet  of  Energy  for  Man  at  Light  Work 49 

Summary 50 

CHAPTER  X— Body  Fuel 

Water 53 

Proteids  53 

Metabolism  54 

Reserves 55 

Diet 56 

Palatability  and  Idiosyncrasy. 57 

Dietetic  Habits ; 58 

Eating  in  Disease 59 

7 


CHAPTER  XI— A  Self-Sufficient  Machine  Page 

In  Health 60 

In  Disease 61 

Starvation  '. 62 

Structural    Relations 63 

CHAPTER  XII— The  Tendency  to  the  Normal 

What  is  Normal? 65 

Heredity   66 

Variation  67 

Adaptation   68 

CHAPTER  XIII— The  Etiology  of  Disease 

Abnormal  Structural  Conditions 70 

Gross  Lesions •  70 

Lesions  of  Less  Degree 71 

CHAPTER  XIV— Disease  Maintained  by  Structure 

CHAPTER  XV— The  Lesion 

The  Causes  of  Lesions 78 

Mechanical  79 

Thermal  79 

Internal  Causes 80 

CHAPTER  XVI— Maintenance  of  the  Lesion 

CHAPTER  XVII— Media  Through  which  Lesions  Produce  Disease 

CHAPTER  XVIII— Varying  Effects  of  Lesions 

Adaptation   88 

Varying  Symptoms 89 

Reflex   Effects : 90 

CHAPTER  XIX— Abuse  of  Function 

Time  Relations 92 

Intensity  93 

Diminished  Functions 93 

Perversions  94 

CHAPTER  XX — Predisposing  and  Exciting  Causes  of  Disease 

CHAPTER  XXI— The  Germ  Theory  of  Disease 

Local  Effects 99 

Constitutional  Effects 99 

Immunity    100 

CHAPTER  XXII— Methods  of  Protection  Against  Bacteria 
CHAPTER  XXIII— The  Diagnosis  of  Disease 

Fever  107 

Digestive   Reactions 108 

Pulmonary  Reactions 109 

Glycosuria 109 

Inflammation  110 

8 


CHAPTER  XXIV— Methods  of  Examination  Page 

Palpation [ 112 

Percussion    113 

Auscultation 113 

Mensuration 113 

Instruments   114 

CHAPTER  XXV— The  Diagonsis  of  Lesions 

Examination  115 

Perversion  of  Function 116 

Attitude  116 

Landmarks 117 

Sensory   Perversions 117 

CHAPTER  XXVI— Pain  in  Lesioned  Areas 

Referred   Pain 119 

Anatomical  Relations 120 

Central  Origin  of  Pain ...121 

Hypersensitive  Areas 122 

CHAPTER  XXVII— Muscular  Changes  in  Lesioned  Areas 

Amplitude 124 

Temperature   Changes 125 

CHAPTER  XXVIII— The  Treatment  of  Disease 

Prophylaxis  and  Therapeutics 127 

Lesion  in   Prophylaxis 129 

Corrective  Versus  Palliative  Treatment 130 

CHAPTER  XXIX— Adjustment  of  Osseous  Lesions 

Exaggeration  133 

Rotation    134 

Pressure 134 

CHAPTER  X^QC— Adjustment  of  Muscular  Lesions 

Relaxation  for  Diagnosis 136 

Relaxation  as  Preliminary  to  Treatment 137 

Relaxation  of  Primary  Lesions 137 

Methods    : 138 

Pressure 139 

Stretching  , , 139 

Approximation 140 

CHAPTER  XXXI— Treatment  of  Other  Lesions 

Tumors    142 

Connective  Tissue   Lesions 142 

CHAPTER  XXXII— Time  Required 

Frequency  of  Treatment 146 

Length  of  Treatment 147 

CHAPTER  XXXIII— Stimulation  and  Inhibition 
CHAPTER  XXXIV— Difficulties  of  Direct  Control 
CHAPTER  XXXV— Use  and  Abuse  of  Direct  Control 

Indications  for  Attempts  at  Direct  Control 159 

CHAPTER  XXXVI— Treatment  of  Disease  Caused  by  Abuse 
CHAPTER  XXXVII— Osteopathy  and  Cell  Life 
CHAPTER  XXXVIII— Cells  of  Multicellular  Organisms 
CHAPTER  XXXIX— Cell  Response  to  Stimulation 

9 


CHAPTER  I 

INTEODUCTORY 

A  statement  of  the  principles  which  underlie  the  science  of 
osteopathy  must,  in  the  nature  of  things,  be  a  very  incomplete  one. 
No  one  recognizes  the  fact  more  thoroughly  than  does  the  prac- 
titioner himself  when  he  is  compelled  to  apply  theoretical  proposi- 
tions to  actual  cases.  Nor  should  he  be  surprised  at  the  discovery. 
K,  as  we  continually  reiterate,  osteopathy  is  a  system  built  upon  the 
facts  of  anatomy  and  physiology,  then  the  foundation  must  be  an 
absolute  and  knowable  one  before  we  may  presume  to  pronounce 
the  building  in  any  sense  complete.  Unfortunately  for  the  im- 
mediate completion  of  the  building,  the  foundation  itself  is  un- 
finished, and  for  an  indefinite  period  of  time  must  remain  so.  It  is 
a  perennially  recurring  surprise  to  the  student  of  the  biological 
sciences,  to  learn  that  in  comparison  with  what  is  yet  to  be  deter- 
mined, the  tptal  of  demonstrable  fact  relating  to  these  sciences  is 
relatively  so  small.  When  the  student,  in  taking  up  the  study  of 
osteopathy,  is  told  that  the  osteopath  is  successful  by  virtue  of  his 
complete  knowledge  of  anatomy  and  physiology,  he  glories  in  the 
assertion.  But  when  he  learns  how  meager  is  the  equipment  of  the 
most  expert,  he  is  likely  to  be  disappointed.  True,  in  anatomy  we 
are  comparatively  well  grounded,  but  our  knowledge  of  physiology 
and  its  related  sciences  is  extremely  unsatisfactory  and  must  remain 
so  for  long.  Why  need  we  then  apologize  for  an  incomplete  state- 
ment of  the  principles  of  osteopathy?  We  are  not  alone  in  this. 
The  handicap  of  limited  knowledge  applies  equally  to  all  therapeutic 
systems.  Indeed  osteopathy  can  claim  an  advantage  in  the  use  of 
what  is  known,  from  its  sole  possession  and  recognition  of  the  correct 
principles  of  interpretation  and  application  of  that  knowledge.  But 
another  fact  is  very  apparent.  Dr.  Still  himself  has  repeatedly 
asserted  that  osteopathy  is  yet  in  its  infancy.  Why  pretend  then 
that  there  be  any  possibility  of  presenting  it  in  the  garb  of  maturity  ? 
Because  of  its  youth,  we  must  be  content  with  a  proper  modesty  of 
statement.  It  is  unfortunate  that  in  the  rapid  growth  of  the  system 
and  in  the  increase  in  number  of  its  adherents,  sufficient  time  has  not 
been  given  to  a  careful  analysis  and  record  of  cases  which  tend  to 

11 


12  PRINCIPLES  OF  OSTEOPATHY 

substantiate  the  fundamental  propositions ;  and  since  only  an  infinite 
number  of  observed  instances  will  satisfy  the  demands  of  inexorable 
logic,  the  necessary  data  have  not  yet  been  collected  to  warrant 
unqualified  statement.  A  careful  presentation  of  certain  very  gen- 
eral but  unequivocal  propositions,  supplemented  by  numerous  pro- 
visional ones,  is  the  duty  of  him  who  would  formulate  a  "plan  and 
specification,"  upon  which  the  practitioner  is  to  build  his  super- 
structure. 

An  Art  and  a  Science 

It  is  further  necessary  to  make  a  fairly  clear  distinction  between 
principles  and  practice.  It  is  a  peculiar  characteristic  of  the  average 
beginner  to  long  for  the  opportunity  to  observe  and  experiment  upon 
cases.  He  has  imbibed  the  idea  that  osteopathy  consists  essentially 
in  the  performance  of  certain  movements  upon  the  patient.  But  it 
is  necessary  to  emphasize  that  before  such  movement  shall  be  intelli- 
gently applied,  certain  fundamental  facts  are  essential;  and  it  is  in 
the  development  of  these  required  facts  that  the  principles  of  osteop- 
athy consists.  Dr.  Still  has  repeatedly  emphasized  that  a  "plan  and 
specification"  is  necessary  before  intelligent  work  can  be  done. 
There  must  be  in  the  mind  of  the  student  a  "living  picture,"  not 
only  of  the  form  and  feature  but  also  of  the  function,  the  tendencies 
toward  and  away  from  the  line  marked  out  by  heredity,  and  every 
phase  and  fact  that  may  be  known  regarding  the  complete  life  of 
the  individual.  It  is  true  no  such  picture  was  held  by  the  pioneer  in 
earlier  times.  It  is  true  that  osteopathy,  like  all  other  sciences  had 
its  beginning  as  an  art.  It  is  no  discredit  to  the  science  that  the  art 
occupies  first  place  in  point  of  time.  Musicians  and  poets  were  born 
and  the  art  of  music  and  poetry  existed  long  before  the  laws  of 
harmony  and  meter  were  known.  But  it  is  significant  that  there  are 
tew  great  poets  or  musicians  who  are  ignorant  of  the  laws  under- 
lying their  art.  The  farmer  may  be  able  to  produce  a  crop  with  no 
knowledge  Avhatever  of  the  chemistry  of  soils  or  the  laws  of  plant 
growth,  but  the  present  development  of  agriculture  could  never  have 
been  reached  had  not  such  laws  been  discovered  and  formulated. 
The  school  teacher  may  be  able  to  develop  the  minds  of  the  young 
and  yet  be  ignorant  of  pedagogics,  but  he  can  never  occupy  first 
place.  Osteopathy  is  no  exception  to  this  rule.  Dr.-Still  mentions 
the  laet  that  while  yet  a  boy,  a  case  of  headache  was  aborted  by 


I NTRODUCTORY  1 3 

resting  his  suboccipital  region  within  a  rope  swing/  That  was  the 
art  of  osteopathy.  Similar  eases  and  observation  of  other  facts 
accumulated  until  an  inkling  was  obtained  of  a  law  underlying  the 
several  facts.  The  recognition  of  that  law  and  the  application  of  it 
to  still  further  cases  constituted  the  beginning  of  the  science.  The 
accumulation  and  systematization  of  facts,  even  though  many  facts 
remained  unexplained,  justified  the  presentation  of  a  working 
hypothesis.  It  is  the  discussion  of  this  hypothesis  and  the  facts 
substantiating  it,  the  taking  it  as  far  as  may  be  from  the  realm  of 
theory  into  the  realm  of  demonstration,  that  constitutes  the  prin- 
ciples of  osteopathy.  The  application  of  the  principles  of  specific 
cases  of  disease  constitutes  the  practice  of  osteopathy. 

A  system  of  healing  cannot  properly  be  separated  from  a  philos- 
ophy of  life.  This  is  true  by  virtue  of  the  involved  nature  of  disease. 
We  may  prate  of  pure  science  and  declare  that  we  will  accept 
nothing  not  susceptible  of  demonstration,  and  that  a  system  of 
healing  must  depend  for  its  permanency  upon  pure  facts  of  observa- 
tion. We  may  insist  that  laboratory  knowledge  is  the  only  brand 
that  will  be  permitted  to  enter  the  sacred  field  of  science.  And  yet 
the  fact  remains  that  the  details  of  every  branch  of  learning  have 
beeu  wrought  out  and  established  through  the  application  of  pre- 
conceived theories  based  upon  comparatively  few  facts.  The  begin- 
ning of  knowledge  comes  by  induction  but  its  completion  is  accom- 
plished only  by  deduction.  A  theory  of  life  is  at  the  basis  of  the 
osteopathic  science.  The  proof  that  it  is  a  law  rather  than  a  theory 
is  the  problem  of  the  osteopathic  reasoner  and  practitioner.  That 
proof  must  of  necessity  require  time,  and  inasmuch  as  confirmative 
evidence  is  daily  accumulated,  let  no  one  be  discouraged. 


^Still:    Autobiography. 


CHAPTER  II 

AN  EVOLUTION  AND  A  REVOLUTION 

What  is  that  philosophy?  It  is  both  an  evolution  and  a  revolu- 
tion. To  make  the  situation  clear  it  is  necessary  to  look  back  into 
history  and  trace  out  so  far  as  may  be  possible  the  evolutionary 
outcroppings  that  have  appeared  from  time  to  time,  culminating 
finally  in  a  condition  that  has  made  possible  the  revolution  inaugu- 
rated by  Dr.  Still.  If  we  turn  to  antiquity  we  find  an  abundance 
of  philosophy  with  little  of  fact.  Remedial  agencies  were  employed 
with  little  regard  to  the  nature  or  the  manifestations  of  the  disease ; 
which  is  not  to  be  wondered  at,  because  of  the  paucity  of  knowledge 
regarding  the  body  either  in  a  condition  of  health  or  of  disease. 

Ancient  Practices 
Is  is  true  the  records  would  indicate  that  in  the  time  of  the 
Ptolemies,  post-mortems  were  held ;  the  ancient  Brahmins  were  aware 
of  the  variations  in  the  specific  gravity  of  the  urine  dependent  upon 
diseased  conditions,  and  practiced  a  crude  form  of  urinalysis ;  in  some 
respects  the  remedial  measures  of  that  day  may  be  considered  a  lost 
art,  for  the  legends  have  it  that  measures  were  known,  the  use  of 
which  would  prevent  the  pitting  of  smallpox,  and  antidotes  effica- 
cious for  the  most  venomous  of  snake  poisons  were  compounded.  The 
Chinese  recognized  the  diagnostic  value  of  changing  conditions  of 
the  pulse,  though  the  connection  between  the  condition  observed  and 
the  remedy  employed  is  unexplained.  The  Hebrews,  while  recogniz- 
ing certain  fundamental  facts  in  regard  to  the  ethical  relations 
existing  between  man  and  man,  and  the  moral  relations  between  man 
and  his  Creator,  gave  to  the  world  little  of  value  in  the  way  of  treat- 
ment of  individual  body  conditions.  The  world  is,  however,  indebted 
to  that  race  for  the  most  elaborate  system  of  hygiene  that  has  been 
devised,  some  of  the  provisions  of  which  might  well  be  incorporated 
in  modern  hygienic  and  sanitary  regulations. 

Age  of  Hippocrates 

Until  the  era  of  Hippocrates  little  of  a  permanent  nature  was 
{jiven  to  the  world  that  would  assist  in  solving  the  problems  of  dis- 

14 


AN    EVOLUTION   AND   A   REVOLUTION  15 

ease  and  death.  In  Hippocrates  (460 — 377  B.  C.)  the  medical  world 
recognizes  its  first  great  figure,  not  so  great  by  virtue  of  any  great 
depth  of  reasoning,  but  because  of  his  ability  to  observe,  and  further, 
by  his  recognition  of  the  necessity  for  recording  his  observations. 
LTence  in  the  Hippocratic  collection  of  writings  is  found  a  vast  field 
covered,  embracing  as  it  does  every  branch  of  the  healing  art,  both 
of  prophylaxis  and  therapeutics.  Hippocrates  further  deserves  the 
title,  "Father  of  Medicine,"  because  of  his  work  in  gathering  to- 
gether not  only  his  own  observations,  but  also  those  of  his  contem- 
poraries and  his  predecessors  which  he  considered  worthy.  It  must 
be  noted,  however,  that  the  value  of  the  observations  of  Hippocrates 
lies  in  their  relation  to  the  symptoms  rather  than  in  the  explanations 
or  the  treatment  of  disease.  He  added  to  the  knowledge  of  effects 
but  not  to  the  knowledge  of  cause  or  its  removal.  The  philosophers, 
Aristotle  and  Plato,  with  their  contemporaries,  dealt  largely  with 
speculation  and  little  with  experimental  determination.  It  is  inter- 
esting to  note  that  in  their  time  arose  the  pneuma  theory,  or  the 
theory  of  the  spirits,  which  in  effect  was  the  precursor  of  Priestly 's 
demonstration  a  thousand  years  later,  of  the  presence  of  oxygen  in 
the  air  and  of  the  important  role  that  element  plays  in  all  life 
processes.  The  same  era  produced  Empedocles  and  Heraclitus,  who 
with  their  theories  of  evolution  and  the  struggle  for  existence,  re- 
spectively, anticipated  Darwin  and  his  followers. 

Galen 

While  the  modern  biological  investigator  has  reverence  for  the 
name  and  fame  of  Hippocrates,  he  recognizes  in  the  Roman  anat- 
omist Galen  (131 — 201  A.  D.)  the  first  investigator  endowed  with 
the  so  called  scientific  spirit.  That  spirit  was  manifested  in  experi- 
mental methods  of  study  which  were  careful  for  that  age  of  the 
world.  As  an  anatomist  and  physiologist,  Galen  was  able  to  disprove 
some  of  the  contentions  of  the  Hippocratic  school  as  well  as  to  add 
a  considerable  number  of  important  facts  to  existing  knowledge  by 
dissections  and  vivisections.  That  Galen's  influence  was  profound 
and  permanent  is  evidenced  from  the  fact  that  certain  of  his  classifi- 
cations are  still  employed,  and  that  for  fourteen  centuries  his  word 
was  law.  In  spite  of  his  contribution  to  biological  knowledge  Galen 
added  in  a  direct  way  not  a  Avhit  to  the  understanding  of  the  cause 
or  the  treatment  of  disease. 


16  PRINCIPLES  OF  OSTEOPATHY 

The  Middle  Ages 

From  the  time  of  Galen  throughout  the  Middle  Ages  up  to  the 
fifteenth  century,  little  advance  was  made  in  any  of  the  sciences 
related  to  the  healing  art.  Through  the  schools  of  Prance,  Italy, 
and  Spain,  fact  and  tradition  were  preserved  unmodified.  All 
knowledge  centered  in  the  records  of  Galen  until,  with  the  general 
revival  of  learning  individuals  once  more  began  to  investigate  and 
reason  for  themselves.  A  striking  character  arose  early  in  the 
sixteenth  century.  Disputant,  philosopher,  mystic  and  egoist, 
Paracelsus  (1493 — 1541)  proclaimed  to  the  world  a  profound  con- 
tempt for  the  learning  of  the  past  as  recorded  in  books,  insisted  that 
knowledge  must  be  gained  subjectively,  and  formulated  a  theory  of 
nature.  Three  of  his  affirmations  should  be  emphasized,  first,  all 
nature  is  a  unit;  second,  nature  is  never  complete,  but  forever  be- 
coming ;  third,  nature  is  a  macrocosm,  man  a  microcosm.  That  these 
three  ideas  have  become  part  and  parcel  of  modern  thought,  is  a 
proposition  requiring  little  substantiation.  The  close  relation  that 
they  bear  to  the  osteopathic  doctrine  becomes  more  and  more  ap- 
parent with  further  study.  From  this  time  forward  the  path  of 
history  is  marked  with  the  names  of  individuals  who  stand  out 
prominently  because  of  added  biological  facts  or  demonstrable 
theorems.  Harvey  (1578 — 1657)  gave  the  proofs  of  a  complete 
circulation  and  the  dictum,  in  its  essentials  never  yet  refuted,  omne 
vivum  ex  ovo,  the  former  of  which  had  been  suggested  by  Galen  and 
by  others  less  noted.  We  need  hardly  dwell  upon  the  importance  of 
both  of  these  facts  to  the  osteopath.  Van  Helmont  (1577 — 1644) 
a  follower  of  Paracelsus,  emphasized  the  interrelations  between 
matter  and  energy,  and  suggested  the  doctrine  of  ferments  as  ex- 
plaining the  digestive  processes.  The  philosopher,  Descartes 
(1506 — 1650),  while  emphasizing  certain  and  numerous  ideas  of  a 
general  nature  regarding  matter  and  mind,  gave  rise  to  one  concept 
that  is  of  the  utmost  significance  to  the  osteopath.  The  idea  that 
man  is  a  machine  and  that  the  operation  of  his  organism  is  dependent 
upon  mechanical  laws,  is  a  view  fundamental  to  osteopathic  reason- 
ing, and  to  Descartes  we  are  under  obligations  for  emphatic  state- 
ment to  that  effect.  Growing  out  of  this  conception  arose  the 
iatro-mechanical  school,  whose  chief  advocates,  Borelli  (1608 — 1679) 
and  ^larey  of  our  own  time,  have  made  the  application  chiefly  to  the 
svstiMiis  of  animal  movement;  while  a  rival  school,  the  iatro-chemical, 


AX    EVOLUTION    AND    A    REVOLUTION  17 

founded  by  Sylvius,  insisted  on  the  application  of  chemical  prin- 
ciples as  explanatory  of  the  various  functions. 

At  this  stage  in  the  historical  development  an  immense  impetus 
was  given  to  the  investigation  of  the  problems  of  life  by  the  inven- 
tion of  the  compound  microscope  whereby  not  only  the  cellular  the- 
ory of  living  structure  was  formulated,  but  also  the  discovery  was 
made  of  microscopic  forms  of  life.  This  was  followed  first  by  the 
interminable  discussion  of  spontaneous  generation  and  later  gave 
birth  to  the  germ  theory  of  disease,  a  theory  which  has  profoundly 
modified  medical  thought  and  practice  during  the  closing  years  of 
the  nineteenth  century.  In  the  latter  half  of  the  seventeenth 
century  the  English  physician,  Thomas  Sydenham,  emphasized 
another  fact  which  is  basic  to  osteopathic  theory.  He  made  emphatic 
claims  for  the  healing  power  of  nature  and  thereby  anticipated  the 
contentions  of  all  those  of  later  time  who  insist  that  it  is  nature 
who  cures  and  not  the  physician.  Priestly,  in  the  latter  half  of 
the  eighteenth  century,  by  his  discovery  of  the  element  oxygen  was 
able  to  replace  in  substantial  form  the  pneuma  of  the  early 
philosophers,  which,  entering  the  body  through  the  breath  gave 
life  to  its  tissues.  Haller  (1708 — 1777),  following  Glisson  in  the 
investigation  of  the  property  of  irritability,  enlarged  upon  the 
conception  of  a  vital  force  underlying  all  life  phenomena  and 
independent  of  known  chemical  and  physical  laws — a  conception 
which  still  commands  the  adherence  of  a  respectable  number  of 
scientists,  and  which  is  yet  perhaps  neither  susceptible  of  proof 
nor  disproof.  The  relation  existing  between  physiological  activity 
and  electricity  has  been  the  subject  of  study  since  Galvani  (1737 — 
1798)  proved  the  generation  of  electric  currents  by  living  tissues, 
and  the  recentlj'^  discovered  facts  of  physical  chemistry  regarding 
the  electrical  nature  of  certain  chemical  reactions  bid  fair  to  throw 
further  light  upon  the  part  played  by  electric  energy  in  the  body 
organism. 

Modern  Times 

During  the  nineteenth  century  a  few  figures  stand  out  strongly 
in  the  further  development  of  biology.  In  special  prominence  is 
noted  the  tendency  of  all  modern  investigators  to  an  objective 
study,  leaving  severely  alone,  too  severely  perhaps,  all  matters  of 
a  speculative  nature.    Bichat  (1801)  remade  the  science  of  anatomy 


18  PRINCIPLES  OF  OSTEOPATHY 

antl  showed  that  disease  had  its  seat  in  the  constituent  tissues 
and  not  in  the  organs  as  such.  Hahnemann  (1775 — 1843),  with 
his  "law  of  similars"  and  his  insistence  on  smaller  dosages,  has 
most  profoundly  modified  the  practice  of  heroic  drugging  which 
had  reached  an  alarming  stage.  Virchow  (1821 — 1902),  with  his 
investigation  into  the  pathology  of  cells,  has  cleared  up  many  of 
Lh(3  mysteries  associated  with  pathologic  conditions,  incidentally 
throwing  light  upon  the  general  cell  doctrine,  although  his  views 
and  those  of  his  followers  "can  but  be  regarded  as  extreme  and  in 
some  respects  impossible.  Ling  (1776 — 1839),  by  virtue  of  his 
systematization  of  the  various  methods  of  movement  cure,  gave  an 
impetus  to  the  study  of  the  physiological  effects  of  mechanical 
stimuli,  a  fact  which  has  led  to  no  little  confusion  on  the  part  of 
both  the  laity  and  profession,  in  regard  to  the  distinction  between 
these  various  methods  and  that  of  osteopathic  practice.  Hilton,  the 
English  surgeon,  has  emphasized  Sydenham's  contention  relating 
to  the  healing  power  of  nature,  in  its  surgical  aspects,  and  has 
served  to  show — innocently  enough — the  essential  identity  in  the 
standpoint  of  osteopathy  and  conservative  surgery.  Pasteur  and 
Koch  and  Klebs  and  a  host  of  others,  through  their  investigations 
into  the  processes  of  fermentation  in  and  out  of  the  body,  together 
with  the  demonstration  of  the  close  relationship  between  disease 
and  micro-organisms,  have  greatly  added  to  our  knowledge  of  the 
pathological  changes  taking  place  in  many  diseases.  Modern 
biologists  have  added  a  vast  amount  of  data  to  the  sum  of  knowledge 
accumulated  in  the  past,  and  to  them  the  members  of  all  schools 
of  healing  are  greatly  indebted.  In  so  far  as  that  knowledge  has 
been  applied  in  explaining  the  cause  of  disease  and  suggesting  its 
treatment  there  is  a  pitiable  poverty.  The  ground  work  for  a 
rational  system  was  laid.  The  inauguration  of  that  system  remained 
for  a  leader.  The  use  of  drugs,  which  had  come  to  occupy  first 
place  among  the  healing  agencies,  was  found  sadly  wanting.  As 
early  as  the  first  half  of  the  last  century,  the  tendency  of  the  later 
time  was  stated  by  Krukenberg,  a  German  physician,  in  these  words 
as  quoted  by  Park:  "Physicians  should  be  filled  with  a  pious 
reverence  toward  nature;  the  organism  is  a  whole  and  must  be 
contemplated  in  this  sense;  medical  art  is  undoubtedly  capable  of 
decisive  action,  but  let  us  not  mistake  that  in  many  cases  its  activity 
i?!  quite  superfluous,  in  very  many  null  and  inadequate,  and  in  many 


AN    EVOLUTION   AND  A  REVOLUTION  19 

injurious."  That  there  has  been  a  remarkable  turning  away  from 
(}rugs  in  the  last  half  century  is  evidenced  from  numerous  facts. 
Note  the  rise  of  Christian  science  and  the  numerous  other  cults 
whose  systems  are  based  on  the  relation  between  mind  and  body, 
which  number  their  adherents  by  the  millions  and  whose  reputed 
cures  emphasize  Krukenberg's  statement  that  in  many  cases  medical 
art  is  superfluous,  and  substantiates  Sydenham's  declaration  that 
the  healing  power  resides  in  nature;  electrotherapy  for  a  time 
flourished  and  still  has  its  enthusiastic  admirers;  hydrotherapy  has 
become  an  adjunct  of  practically  all  systems,  the  use  of  which  has 
been  emphasized  out  of  proportion  to  the  possibility  of  its  abuse; 
the  development  of  serotheraphy  co-existent  with  the  development 
of  a  knowledge  of  toxins  produced  by  pathogenic  bacteria  has  had 
far  reaching  results ;  the  known  facts  relating  to  internal  secretions, 
together  with  the  observation  of  pathologic  conditions  resulting 
from  the  absence  of  some  organ,  usually  a  ductless  gland,  has  led  to 
the  rise  of  organotherapy,  and  has  served  to  distinguish  between 
organic  food  elements  and  inorganic  chemical  substances.  The  rise 
of  these  various  systems,  all  indicating  the  desertion  of  the  drug 
has  not  been  dependent  upon  a  realization  by  the  physician  alone 
of  the  inadequacy  of  the  drug,  but  equally  upon  that  realization 
by  the  thinking  laity.  The  time  was  ripe  for  a  revolution  in  the 
conception  of  cause  and  treatment  of  disease. 


CHAPTER  in 

THE  REVOLUTION 

It  was  stated  that  in  osteopathy  not  only  was  there  an  evolution 
but  there  Mas  a  revolution.  Heretofore  the  physician  had  confined 
his  attention  to  the  appearances  in  disease,  which  in  truth  was  all 
that  he  could  do  inasmuch  as  the  cause  remained  unknown.  Every 
sj^stera  of  treatment  thus  far  developed  had  been  one  designed 
primarily  to  combat  effects.  It  remained  for  Dr.  Still  to  determine 
the  fundamental  cause  of  all  disease  and  to  inaugurate  a  system 
of  treatment  based  upon  that  cause.  What  constitutes  the  distinc- 
tive feature  of  this  revolution  in  the  concept  of  cause  and  the 
method  of  treatment  of  disease?  All  systems  and  sciences,  whether 
related  to  healing  or  other  aspect  of  human  endeavor,  are  a  result 
of  growth.  Growth  presupposes  a  beginning  less  mature  than  the 
end.  Hence  it  were  presumption  at  the  present  time  to  attempt  to 
set  definite  limits  to  the  science  of  osteopathy.  Professor  Ladd 
of  Yale  states  a  very  important  fact  when  he  says  that  the  proper 
definition  of  a  science  is  one  of  the  latest  and  most  difficult  achieve- 
ments of  that  science.  Recognizing  the  extreme  youth  of  osteopathy 
we  must  be  content  with  only  a  provisional  setting  of  limitations 
in  any  attempt  at  a  statement  of  its  constituent  elements.  Admitting 
tills  to  be  the  case,  yet  it  is  not  deemed  presumptuous  to  attempt 
to  fornuilate  in  a  concise  manner  the  essential  ideas  in  the  form  of 
what  may  be  called  a  definition.  We  certainly  cannot  assent  to 
the  proposition  that  no  statement  of  principles  shall  be  given  definite 
form  because  we  may  have  reason  at  a  later  time  to  retreat.  A 
policy  of  negation  is  as  destructive  to  all  progress  in  science  as  it 
is  in  politics.  If  the  system  of  osteopathy  is  to  be  advanced,  if 
it  is  to  be  established  upon  demonstrable  law,  if  it  is  to  be  relegated 
to  the  oblivion  of  error  it  will  be  developed  in  the  best  possible 
manner  by  giving  it  definite  direction  and  force  through  the  formu- 
lation of  a  specific  program  based  upon  a  definite  working 
hypothesis.  From  time  to  time  as  further  discovery  of  truth  shall 
suggest,  that  program  or  hypothesis  may  be  modified.  It  is  signifi- 
cant that  thus  far  in  the  history  of  its  development  no  fact  has 
been    demonstrated    that    has   modified    in    any    essential   way    or 

20 


THE  REVOLUTION  21 

degree  the  primal  osteopathic  concept.  If  care  be  taken  to  analyze 
the  apparently  contradictory  conditions  which  have  been  reported 
we  believe  that  it  will  be  found  that  instead  of  modifying  the 
original  concept,  they  but  confirm  and  make  it  the  more  impreg- 
nable. 

It  is  needless  to  say  that  a  single  word  cannot  indicate  in  any 
comprehensive  way  the  nature  of  the  system.  Hence  no  attempt  is 
made  to  explain  in  any  apologetic  or  compromising  terms  why  the 
word  osteopathy  came  to  us.  It  is  insisted,  however,  that  as  com- 
pared to  the  terminology  of  other  systems  the  word  osteopathy  is 
much  more  representative  of  the  system  and  is  far  superior  to  any 
other  name  that  has  been  suggested.  The  legal  definition  given  to 
the  system  by  statutes  refers  to  it  as  a  "system,  method,  or  science 
of  healing."  That  it  is  systematic  and  methodical  is  recognized 
at  a  glance.  The  more  pertinent  inquiry  remains,  is  it  a  science? 
That  it  is  not  a  completed  science  has  already  by  inference  been 
emphasized.  That  it  embraces  all  the  elements  of  a  science  is 
affirmed.  The  definitions  that  have  been  given  for  the  word  science 
have  been  many  and  various.  Succinctly,  systematized  truth  may 
^erve  the  purpose  as  well  as  many  of  a  more  pretentious  character. 
In  so  far  as  the  facts  that  have  been  gathered  when  arranged  in 
definite  logical  order  tend  to  support  a  definite  hypothesis,  we  have 
a  science.  In  so  far  as  the  conditions  in  disease  are  shown  to  depend 
in  definite  ways  upon  certain  properties  of  the  structural  arrange- 
ments, thereby  occupying  the  relation  of  cause  and  effect,  we  have 
the  essentials  of  a  science.  Finally,  inasmuch  as  anatomy  and 
physiology  are  sciences,  osteopathy,  which  is  but  the  application 
oC  these  two  toward  the  cure  of  disease,  must  partake  also  of  the 
nature  of  a  science.  True,  there  are  many  things  in  the  osteopathic 
system  yet  to  be  recognized  and  classified,  but  that  fact  does  not  in 
any  way  impair  its  validity  as  a  science. 

Not  touching  upon  the  details  that  yet  remain  to  be  worked  out, 
a  technical  definition  must  suggest  a  theory  of  the  cause,  and  the 
treatment,  of  disease.  In  regard  to  the  latter  it  must  embrace  not 
only  therapeutics  but  prophylaxis  as  well.  For  medicine  in  the 
broad  use  of  that  term  must  include,  in  addition  to  measures  em- 
ployed to  assist  the  body  in  recovering  its  equilibrium,  also  those 
designed  to  assist  the  organism  in  maintaining  that  equilibrium. 
Indeed  the  latter  is  logically  of  far  greater  importance,  but  because 


22  PRINCIPLES  OF  OSTEOPATHY 

of  an  unfortunate  tendency  on  the  part  of  human  nature  to  pro- 
crastination the  former  will  of  necessity  demand  the  most  of  the 
physician's  labor.  In  order  that  the  definition  shall  include  essen- 
tials and  provide  a  basis  of  support  the  following  propositions  must 
be  either  directly  or  by  inference  included: 

1 .  Cure  is  the  prerogative  of  the  organism. 

2.  Functional  disorders  will  be  self -adjusted  except  where  com- 
plicated with  or  dependent  on  structural  disorders  which  are  beyond 
the  limits  of  self-adjustment. 

3.  Removal  of  structural  disorders  constitutes  the  treatment. 

In  accordance  with  these  provisions  the  author  has  elsewhere 
suggested  the  following  definition  of  the  distinctive  features  of 
osteopathy:  A  system  of  therapeutics  which,  recognizing  that  the 
maintenance  and  restoration  of  normal  function  are  alike  dependent 
on  a  force  inherent  in  protoplasm,  and  that  function  perverted 
beyond  the  limits  of  self -adjustment,  is  dependent  on  a  condition 
of  structure  perverted  beyond  those  limits,  attempts  the  reestablish- 
inent  of  normal  function  by  manipulative  measures  designed  to 
lender  to  the  organism  such  aid  as  will  enable  it  to  overcome  or 
adapt  itself  to  the  disturbed  structure.^  The  elaboration  of  the 
various  provisions  in  this  definition  will  appear  as  the  subject  is 
further  developed  in  the  following  chapters. 

The  definition  offered  by  Dr.  C.  B.  Atzen  and  approved  by  the 
American  Osteopathic  Association,  June  29,  1919,  is  as  follows: 
"Osteopathy  is  that  system  of  the  healing  art  which  places  the 
chief  emphasis  upon  the  structural  integrity  of  the  body  mechanism 
as  being  the  most  important  single  factor  in  maintaining  the  well- 
being  of  the  organism  in  health  or  disease." 


MoTirnal  of  The  American  Osteopathic  Association,  May,  1902. 


CHAPTER  IV 

SOME  FUNDAMENTAL  CONSIDERATIONS 

Viewpoint  of  Life 

In  another  connection  it  was  stated  that  a  system  of  healing 
cannot  be  separated  from  a  philosophy  of  life.  As  introductory  to 
a  further  study  of  the  osteopathic  doctrine  it  is  necessary  to  consider 
in  brief  a  few  aspects  of  the  life  problem.  Not  that  it  is  possible 
to  give  an  accurate  definition  of  life ;  for  it  is  obvious  that  no  such 
definition  can  be  given  of  a  thing,  the  essential  nature  of  which  is 
unknown.  For  we  know  not  what  life  is;  we  are  only  acquainted 
in  part  with  the  substance  with  which  life  is  associated  and  with 
a  few  of  its  manifestations.  "We  know  that  in  one  sense  life  is  a 
property  of  a  certain  kind  of  molecule  but  the  explanation  of  the 
property  and  how  it  is  associated  with  the  molecule  is  not  forth- 
coming. We  know  that  life  is  inherent  in  this  certain  kind  of 
molecule.  Dr.  Still  has  stated  that  life  is  an  individualized  principle 
of  nature.  A  part  of  the  universal  life  has  become  individualized 
in  an  aggregation  of  protoplasmic  molecules.  How  it  became  thus 
individualized,  and  at  death  again  becomes  merged  into  the  uni- 
versal life,  is  yet,  and  in  all  likelihood  will  always  remain,  a  mystery. 
The  materialist  hopes  sometime  to  be  able  to  explain  life  in  terms 
of  physics  and  chemistry.  While  it  is  true  that  a  large  number 
of  functions  formerly  considered  vital,  in  the  sense  of  being  out  of 
the  realm  of  physics  and  chemistry,  have  in  more  recent  years 
been  in  their  gross  app-earances  satisfactorily  explained  on  purely 
physical  or  chemical  laws,  yet  a  vast  number  of  much  more  difficult 
functions  as  well  as  the  finer  details  of  every  function  remain 
entirely  beyond  physical  or  chemical  explanation. 

While  it  is  thus  not  possible  to  accept  the  materialist's  concep- 
tion of  living  matter  yet  recognition  must  be  made  of  the  funda- 
mental importance  of  chemical  and  physical  law  as  a  basis  for 
functioning.  The  chemical  nature  of  protoplasm  is  significant; 
composed  of  a  dozen  or  more  of  the  known  elements  most  of  which 
are  of  low  atomic  weight,  we  find  a  very  complex  molecule.  If 
paramount  importance  can  be  assigned  to  any  single  element,  nitro- 

23 


24  PRINCIPLES  OF  OSTEOPATHY 

geii  could  reasonably  be  placed  first.  That  element  is  characteristic 
of  living  material  and  is  fundamental  in  giving  to  the  complex 
molecule  some  of  its  own  peculiarities.  Nitrogen  unites  with  a  suffi- 
ciently large  number  of  other  elements  but  in  comparatively  loose 
combinations,  separating  readily  to  form  new  associations.  It  is  in 
this  respect  that  nitrogen  is  of  prime  importance  to  the  living  mole- 
cule. The  most  striking  characteristic  of  living  tissue  is  its  tendency 
to  continuous  change  not  only  of  a  physical  but  also  of  a  chemical 
nature.  The  response  to  a  stimulus  is  dependent  upon  this  readiness 
and  since  life  may  be  considered  in  large  part  a  response  to  stimuli 
the  necessity  for  the  ability  to  change  becomes  apparent.  In  this 
connection  Herbert  Spencer's  classical  definition  of  life  is  illuminat- 
ing :  The  continuous  adjustment  of  internal  relations  to  external  re- 
lations. As  there  will  be  occasion  to  refer  repeatedly  to  the  fact  of 
adjustment  this  conception  of  life  should  be  borne  in  mind.  Every 
cliange  in  the  environment  of  the  organism  constitutes  a  stimulus  of 
greater  or  less  intensity  upon  that  organism.  The  continuous  proper 
response  to  these  stimuli  represents  a  normal  condition  of  the 
organism;  a  failure  to  respond,  or  a  response  too  intense  or  in- 
sufficient is  evidence  of  and  further  cause  for  a  disease  condition. 
In  the  sense  of  a  continuous  response  to  continuous  stimuli  the 
organism  constitutes  what  Spencer  calls  a  moving  equilibrium. 
AVhen  that  equilibrium  becomes  disturbed  by  too  intense  or  too 
prolonged  stimuli  disease  results,  while  in  the  continuous  adjustment 
to  circumstances  is  seen  the  normal  condition  of  the  living  organism. 

Considering  life,  then,  in  certain  of  its  manifestations,  it  is 
observed  that  the  law  of  change  is  a  law  of  living  matter  as  rep- 
resented in  man.  The  study  of  those  changes  and  the  determination 
(*r  methods  to  assist  the  organism  in  its  response  to  normal  stimuli 
and  in  its  resistance  to  abnormal  stimuli,  constitutes  the  life  problem 
(»f  tbo  physician. 


CHAPTER  V 

STKUCTUKE  AND  FUNCTION 

In  this  continuous  adjustment  dtependent  on  change  in  the 
physical  and  chemical  relations  of  the  molecule  above  referred  to  it 
IS  to  be  noted  that  both  structure  and  function  are  concerned. 
Discussions  are  rife  regarding  the  relative  position  of  structure  and 
function  in  the  development  of  an  individual  or  of  a  race.  It  is 
not  advisable  to  enter  into  the  argument  except  to  indicate  that 
for  all  practical  purposes  the  two  develop  co-ordinately.  That 
structure  changes  function  in  countless  cases  must  be  admitted. 
This  fact  is  fundamental  in  osteopathic  theory,  according  to  which 
most  diseases  are  either  caused  or  maintained  by  structural  condi- 
tions interfering  with  function.  On  the  other  hand  it  is  equally 
certain  that  in  numerous  cases  there  is  evidence  of  the  modifying 
influence  of  function  on  structure. 

The  doctrine  that  makes  the  cell  the  fundamental  biological  unit, 
and  the  physiology  of  the  body  but  the  physiology  of  the  cell,  is 
insufficient  to  explain  all  the  phenomena  of  the  complex,  organized, 
living  being.  The  cell  represents  one  expression  of  life  which  is 
inherent  in  the  common  structural  basis,  protoplasm.  There  is  an 
organizing  force  that  lies  back  of  all  structure  whether  the  latter 
be  composed  of  cells,  intercellular  substance,  or  of  syncytia.  That 
force  is  unknown  but  it  represents  an  action,  an  energy,  a  function. 
In  this  sense  reasoning  is  justified  in  insisting  that  function  is  a 
cause  of  structure.  This  assertion,  however,  may  be  followed  by 
the  equally  obvious  statement  that  before  that  organizing  force 
can  express  itself  in  any  substantial  way  it  must  have  a  structural 
basis.  That  structural  basis  is  protoplasm.  From  this  standpoint 
structure  governs  function.  Throughout  the  growing  period  of  the 
individual,  function  is  continually  changing  structure.  Marey  calls 
attention  to  the  development  of  grooves  and  depressions  in  the 
growing  bone  from  the  continuous  functional  activity  of  the  grow- 
ing muscle  and  other  soft  tissues.  As  the  individual  uses  to  excess 
one  group  of  muscles,  the  prominences  to  which  the  muscles  are 
attached  are  correspondingly  increased.    The  muscle  itself,  as  in  the 

25 


26  PRINCIPLES  OF  OSTEOPATHY 

case  of  the  heart  in  certain  valvular  disorders,  becomes  remarkably 
hypertrophied.  A  disorder  of  the  stomach,  through  the  increase  of 
nerve  impulses  that  pass  from  it,  initiates  changes  which  result  in 
perversions  of  form,  more  noticeable  in  the  case  of  muscle  tissue. 
All  of  these  are  instances  of  the  power  of  function  to  modify  struc- 
ture. In  large  part  it  will  be  noted  that  the  functioning  energy 
only  modifies  the  structure  in  the  process  of  growth,  compensation, 
or  any  condition  where  a  definite  purposeful  action  seems  necessary. 
As  soon  as  the  functional  activity  or  the  energizing  force  has 
hrought  forth  and  builded  its  own  instrument  of  manifestation, 
observation  of  the  human  body,  that  of  the  lower  animal,  and  to 
some  extent,  plant  life,  all  show  that  function  then  becomes  subject 
to  the  mechanical  conditions  of  the  structure  and  form.  Thence  on, 
more  noticeably  than  during  the  previous  period  of  growth  or  com- 
pensation, structure  becomes  modified  only  inappreciably  and 
gradually  by  function.  The  more  inert  structure  once  formed — 
made  ready  for  the  indwelling  of  the  animating  force — if  disturbed 
through  various  forces  acting  upon  it,  is  in  considerable  part  unable 
to  adjust  itself  immediately,  with  the  result  that  the  function  must 
suffer  and  continue  so  to  do  until  the  structural  condition  be  over- 
come with  or  without  the  aid  of  some  extraneous  factor.  Therein 
lies  the  essence  of  the  whole  argument.  Admitting  that  function 
can  modify  the  structure,  it  can  much  more  readily  modify  itself 
and  hence  is  practically  self-adjusting.  On  the  other  hand,  structure 
is  only  passively  self-adjustive  and  hence  will  likely  remain  in  its 
abnormal  condition  until  some  external  force  it  brought  to  bear. 
Here  lies  the  work  for  the  physician.  Structure  is  disturbed. 
F'unction  must  of  necessity  suffer  as  a  result,  and  symptoms  of 
disease  follow.  The  physician  can  attempt  to  change  either  function 
or  structure.  Which  shall  it  be?  Function  being  self-adjusting, 
and  dependent  on  structure  needs  no  artificial  aid.  Structure,  being 
more  helpless  so  far  as  self-adjustment  is  concerned,  and  being 
directly  responsible  for  maintenance  of  the  perverted  function,  de- 
mands the  attention  of  the  physician.  His  work  in  assisting  in 
structural  adjustment  is  the  only  external  or  artificial  factor  that  is 
justified. 

The  Cell  Doctrine 

From  the  middle  of  the  seventeenth  century,  when  Schleiden 
and  Schwann  discovered  in  the  ease  of  plants  and  animals  respec- 


STRUCTURE  AND  FUNCTION  27 

tively  that  living  material  is  composed  of  innumerable  microscopic 
parts  having  a  more  or  less  definite  shape,  up  to  the  present  decade, 
the  cell  doctrine  has  been  growing  in  importance  as  one  of  the 
great  facts  of  biology.  When  the  nature  of  the  cell  was  first  deter- 
mined and  the  so  called  essential  elements  had  been  differentiated 
from  the  non-essential,  it  was  believed  that  a  long  step  had  been 
taken  toward  the  solution  of  many  of  the  life  problems.  As  the 
investigator  learned  that  each  of  these  individual  divisions  had  a 
more  or  less  distinct  life  of  its  own,  the  attention  of  the  physiologist 
was  turned  from  a  consideration  of  the  action  of  cell  groups  to  that 
of  the  individual  cell,  until  in  the  literature  of  to-day  the  statement 
is  constantly  reiterated  that  the  problem  of  physiology  is  the 
problem  of  the  cell.  Virchow,  in  his  monumental  work  on  the  cell 
structure  with  special  reference  to  its  pathology,  has  emphasized 
more  than  any  one  man  the  individuality  of  the  cell  and  the 
fundamental  necessity  for  normal  cell  life  in  order  that  body 
activity  as  a  whole  shall  be  normal.  His  coworkers  and  followers 
have  assisted  very  materially  in  definitely  showing  the  great  part 
played  by  the  cell  in  the  activity  of  every  living  thing.  Yet  while 
all  this  is  true  it  must  be  insisted  that  the  problem  of  physiology 
can  never  be  solved  by  the  rule  of  the  cell,  and  that  for  the  reason 
that  the  cell  is  not  the  fundamental  element  nor  the  essential  fact 
in  living  tissue.  Within  later  years  the  extreme  views  have  been 
modified  and  modern  investigators  are  searching  for  the  demonstra- 
tion of  what  may  provisionally  be  called  the  ante-cellular  elements. 
That  such  exist  there  can  be  little  question.  That  is,  more  simple 
elements  which  have  the  fundamental  life  faculties,  lie  back  of  the 
cell  and  are  responsible  for  the  cell.  If  it  were  asked  what  is  the 
simplest  possible  conception  of  life  *in  its  manifestation,  it  could 
logically  be  insisted  that  protoplasm  plus  an  organizing  force  dwell- 
ing within  that  protoplasm  constitutes  the  simplest  conceiveable 
life  condition.  This  conception  is  not  that  of  the  cell  doctrine  as 
commonly  understood.  The  structural  conditions  necessary  in  the 
cellular  arrangement  are  but  one  of  the  expressions  of  the  life  and 
hence  are  but  incidental.  "All  parts  of  the  cell  are  but  the  local 
differentiation  of  a  common  structural  basis.  "^  The  cytoplasm  is 
one  specialization,  the  nucleoplasm  is  another,  and  the  cell  wall  is 
a  third  of  the  specializations  of  this  structural  basis.     It  is  not 


^Wilson:     The  Cell  in  Development  and  Inheritance. 


28  PRINCIPLES  OF  OSTEOPATHY 

enough  to  say  that  there  must  be  the  combination  of  nucleus  and 
cj'toplasm  in  order  that  life  may  be  manifested.  It  is  a  common 
statement  that  the  nucleus  is  necessary  and  hence  any  protoplasm 
devoid  of  a  nucleus  cannot  represent  the  fundamental  unit.  But 
cytoplasm  does  live  and  does  manifest  life  after  having  been  separ- 
ated from  all  connection  with  nucleoplasm.  It  shows  amoeboid 
movement,  it  is  irritable,  it  flows  about  nutrient  substances  and 
digests  them.  Hence  life  is  still  present  and  without  question  there 
are  present  more  elementary  biological  units.  To  the  objection  that 
the  cytoplasm  very  soon  dies,  and  under  no  circumstances  can 
reproduce  itself,  it  may  be  replied  that  the  same  is  true  of  any  of 
the  complete  cells  of  multicellular  man  when  they  have  become 
separate.  Many  cells  live  in  which  no  nucleus  is  demonstrable.  And 
yet  these  organisms  are  eminently  alive.  They  move  and  select 
or  reject  food  substances  and  reproduce  their  kind.  The  difference 
between  these  and  the  cellular  organisms,  so  far  as  life  itself  is 
concerned,  is  one  only  of  degree  and  complexity,  not  of  kind. 


CHAPTER  VI  . 

UNITY  OF  THE  BODY 

With  modern  methods  of  research  our  knowledge  of  the  actual 
structural  conditions  of  the  human  body  has  been  considerably 
increased  and  in  large  part  corrected.  One  of  the  more  striking 
of  the  observations  which  bear  directly  upon  the  subject  in  hand, 
has  reference  to  the  fact  that  the  body  is  by  no  means  entirely 
made  up  of  cellular  structure.  It  has  long  been  known  that  in 
the  case  of  plants  many  of  their  cells  were  structurally  con- 
tinuous. The  same  fact  has  been  shown  to  be  true  in  the  case  of 
animals.  In  the  developing  ova  of  fishes  it  has  been  found  that  the 
cells  as  they  were  formed  were  not  separated  but  still  maintained 
the  continuity  of  their  protoplasm.  The  same  is  true  with  reference 
to  the  ovarian  cells  of  certain  mammals.  In  the  higher  animals, 
including  man,  many  epithelial  cells  on  close  inspection  show  the 
presence  of  protoplasmic  bridges.  Cartilaginous  and  many  other 
forms  of  connective  tissue  cells  are  connected  through  protoplasmic 
extensions.  In  the  case  of  the  muscle  cells  of  the  heart  is  seen  a 
typical  condition.  There  the  cells  are  markedly  branching  and  the 
branches  are  continuous  one  with  another.  This  is  of  fundamental 
interest,  as  throwing  light  upon  the  peculiar  properties  of  the 
cardiac  muscle.  All  investigators  have  noted  that  the  contraction 
of  the  heart  takes  the  form  of  a  wave  passing  downward  from  the 
sinus  venosus  to  the  apex.  It  was  formerly  assumed  that  this  wave 
was  propagated  from  auricle  to  ventricle  through  the  medium  of 
nerve  connection.  This  is  now  believed  to  be  erroneous,  since  the 
nerve  tissue  can  be  rendered  ineffective  while  the  propagation  of 
the  wave  remains  unaltered.  What  is  the  explanation?  Older 
anatomists  taught  that  there  was  no  muscular  connection  between 
auricle  and  ventricle.  This,  according  to  Gaskell,  has  been  dis- 
proved and  it  is  now  known  that  the  propagation  of  the  contraction 
wave  from  auricle  to  ventricle  may  take  place  through  the  continuity 
of  muscle  protoplasm  or  via  the  atrio-ventricular  or  muscle  bundle 
of  His.  While  the  continuous  nature  of  cardiac  muscle  cells  has  thus 
been  recognized  it  is  only  within  more  recent  years  that  proof  was 
given  for  a  similar  though  less  marked  condition  in  the  case  of  most 

29 


30  PRINCIPLES  OF  OSTEOPATHY 

involuntary  muscle  tissue.  This  becomes  of  special  interest  because 
of  the  fact  that  a  contraction  wave  started  at  one  end  of  the  intes- 
tinal canal  passes  through  a  greater  or  less  extent  of  the  tract 
without  further  stimulus.  Therein  further  lies  the  suggestion  of  an 
explanation  of  the  Traube-Hering  curves  which  are  produced  by 
the  rhythmic  action  of  the  arterial  walls  and  which  are  entirely 
independent  of  the  pulse. 

From  the  above  considerations  it  would  seem  that  the  conception 
oi  the  human  body  as  a  syncytium  is  not  inappropriate,  and  that 
there  is  justification  for  the  conclusion  stated  by  Meyer  that  both 
the  plant  and  the  animal  individual  are  continuous  masses  of  proto- 
plasm in  which  the  cytoplasmic  substance  forms  a  morphological 
unit  whether  in  the  form  of  a  single  cell,  a  multinucleated  cell,  or 
a  system  of  cells.^ 

What  is  the  significance  of  the  cellular  arrangement  ?  Admitting 
that  such  is  present  in  the  organism  in  an  all  but  universal  degree, 
what  purpose  is  subserved  thereby?  Several  suggest  themselves. 
Note  that  the  total  bulk  of  protoplasm  in  a  body  weighing  one 
hundred  and  fifty  pounds  must  be  considerable.  Supposing  this 
bulk  were  homogeneous  and  undivided,  what  would  be  its  structural 
peculiarity  and  its  form?  Protoplasm  is  fluid,  hence  the  lack  of 
mechanical  support  would  be  a  serious  hindrance  to  all  of  its  func- 
tions and  a  complete  prohibition  of  many.  By  virtue  of  the  struc- 
turally differentiated  cell  wall,  the  intercellular  substances,  and  the 
various  deposits  of  lime  and  other  salts,  such  support  becomes 
possible.  A  provision  for  growth  is  a  second  advantage  in  the 
cellular  arrangement.  Note  that  every  living  substance  can  be 
nourished  only  by  the  process  of  absorption  of  foods  through  the 
surface  which  is  presented  to  the  surrounding  medium.  Note 
further  that  as  bodies  grow  the  ratio  of  their  increase  in  bulk  to 
their  increase  in  surface  is  as  the  cube  to  the  square.  Hence  in  order 
that  any  marked  increase  in  size  may  be  possible,  special  means  must 
be  provided  for  an  increase  in  surface,  in  the  absorptive  area 
through  which  food  materials  may  pass  into  the  protoplasmic 
substance.  By  means  of  the  division  and  subdivision  into  more  or 
loss  distinct  cells,  this  increase  in  area  is  provided  for.  A  third 
advantage  is  seen  in  the  possibility  of  specialization  in  function. 
This  is  in  part  dependent  upon  the  changes  of  shape  that  take  plaoe 


1  Wilson:     The  Cell  in  Development  and  Inheritance. 


UNITY  OF  THE  BODY  31 

in  the  cell,  but  more  upon  the  change  in  the  intimate  nature  of  the 
protoplasm  itself — a  change  that  largely  defies  investigation.  It  is 
at  once  apparent  that  a  completely  continuous  and  homogenous  mass 
of  protoplasm  would  be  an  insurmountable  barrier  to  marked  special- 
ization of  function.  The  difficulty  is  materially  reduced  by  the 
mechanical  divisions  produced  in  cellular  development. 

Since  the  cell  is  not  distinct  and  independent,  and  the  body 
may  rightly  be  considered  a  syncytium,  what  are  the  legitimate 
deductions?  Reference  has  previously  been  made  to  the  necessity 
of  considering  the  body  as  a  whole  and  not  as  an  aggregation  of 
independent  particles.  This  is  fundamental  in  the  osteopathic 
philosophy  and  practice.  If  the  body  is  a  unit  then  the  practice  of 
removal  of  any  organ  of  the  body  because  of  its  supposed  absence 
of  function  is  fundamentally  erroneous.  All  organs  and  all  parts 
of  the  body  perform  to  a  certain  extent  all  vital  functions.  "While 
there  is  specialization  no  part  of  the  body  completely  loses  its 
original  properties.  This  emphasizes  the  fact  that  the  human  organ- 
ism manifests  the  most  complete  as  well  as  the  most  simple  function- 
ing capacities,  and  doing  so,  it  can  meet  all  conditions  of  human 
environment  on  a  common  level,  whether  those  conditions  them- 
selves be  complex  or  simple.  And  this  is  of  importance  in  the 
organism's  struggle  for  existence.  When  man  is  compelled  to  resist 
another  organism  of  complex  nature  such  as  other  mammals,  he  may 
do  so  by  the  use  of  his  own  specialized  complex  nature.  He  can 
meet  brain  with  brain  and  muscle  with  muscle.  Compelled  to  resist 
the  effects  of  poisonous  substances,  whatever  the  occasion  for  their 
presence  in  his  body  he  may  meet  toxin  with  anti-toxin.  Compelled 
tc  withstand  invasion  of  his  own  body  by  the  unicellular  organism, 
such  as  a  pathogenic  bacterium,  he  may  meet  cell  with  cell,  for 
phagocytosis  is  an  accepted  physiological  fact.  The  same  idea  is 
emphasized  in  the  case  of  the  internal  secretions.  It  is  known  that 
many  of  the  organs  of  the  body  provide  certain  substances  that  are 
essential  to  the  body  as  a  whole.  It  is  doubtless  true  that  every 
part  of  the  body  gives  and  receives  from  every  other  part,  and 
Spencer's  suggestion  is  significant  that  a  particle  of  protoplasm  may 
during  the  course  of  time  pass  to  all  parts  of  the  body.^ 

A  furthur  interesting  suggestion  along  this  line  refers  to  the 
relation  between  this  bodily  unity  and  various  reflex  disorders  and 


^Herbert  Spencer:     Principles  of  Biology,  Vol.  1.,  p.  192. 


32  PRINCIPLES  OF  OSTEOPATHY 

chains  of  disorders.  A  pathologic  condition  of  a  group  of  cells  may 
affect  the  nerve  connections  or  the  quality  of  the  blood  or,  through 
tlie  added  influence  of  the  flow  of  protoplasmic  substance  or  force, 
may  cliange  the  metabolism  of  remote  structures.  Virchow  himself 
has  suggested  that  the  reticular  arrangement  of  cell  continuity,  will 
much  facilitate  the  conduction  of  various  morbid  processes.^  This 
fact  would  emphasize  the  necessity  of  looking  to  other  parts  of  the 
body  for  irritating  factors  rather  than  merely  to  the  regions  com- 
monly involved  through  a  disturbance  of  the  nerve  or  blood 
mechanism. 

In  like  manner  may  be  understood  the  deleterious  eflFects  on 
other  and  all  parts  of  the  body  from  the  administration  of  drugs. 
It  will  thus  be  impossible  to  limit  the  action  of  a  drug  to  the  tissue 
involved  in  the  disease;  once  having  come  in  contact  with  the 
protoplasm  of  a  single  cell,  unless  thrown  out  by  defensive  action, 
the  chemical  irritant  may  pass  to  every  other  part  of  the  body. 

Emphasis  has  thus  been  laid  upon  the  fact  of  protoplasmic 
continuity,  mainly  to  draw  attention  to  the  necessity  for  considering 
the  body  as  much  more  than  the  sum  of  its  parts.  While  with 
Virchow  we  may  assert  that  "every  animal  presents  itself  as  a  sum 
of  vital  unities,  every  one  of  which  manifests  all  the  characteristics 
of  life, '  '^  this  can  be  but  a  half  truth.  The  cell  in  the  multicellular 
organism  is  certainly  dependent  on  associated  cells  for  its  proper 
performance  of  function.  The  extent  of  that  dependence  is  as  yet 
undetermined.  Recent  investigations  relative  to  the  facts  of  internal 
secretions  suggest  the  supreme  nature  of  this  dependence,  and  while 
the  presumption  is  that  the  secretion  is  given  to  the  blood  and  lymph 
to  be  carried  to  those  dependent  cells,  yet  for  aught  we  know  these 
substances  and  much  more  subtle  influences  may  pervade  the  body 
through  the  medium  of  this  closer  connection  of  protoplasmic 
continuity;  and  we  believe  that  there  is  much  of  practical  value  to 
be  gained  by  considering,  with  Krukenberg,  that  "the  organism  is 
a  whole  and  must  be  contemplated  as  such." 


1  Virchow:     Cellular  Pathology,  p.  76. 
-Virchow:     Ice.  cit. 


CHAPTER  Vn 

CAUSE  OF  DISEASE  NOT  IN  THE  CELL 

Prom  the  extreme  views  of  the  cellular  structure  which  have 
i'oUowed  the  investigations  of  Virchow  and  others,  there  has  arisen 
a  conception  of  disease  which  to  say  the  least  is  decidedly  in- 
adequate. From  the  view  that  the  body  is  but  an  aggregation  of 
groups  of  cells  related  only  through  a  common  nerve  and  blood 
supply,  and  each  of  which  has  its  own  independent  function,  comes 
the  natural  inference  that  disease  constitutes  an  independent  and 
inherent  faulty  condition  in  the  activity  of  those  cells.  By  the 
demonstration  that  protoplasmic  metabolism  was  able  to  synthesize 
various  substances  that  were  auto-toxic,  a  key  to  numerous  diseases 
was  believed  to  have  been  found.  So  far  as  a  superficial  conception 
goes  the  assumption  is  correct.  It  is  true  that  every  cell  and  every 
particle  of  protoplasm  may  produce  substances  which  are  actively 
toxic  to  the  living  protoplasm  if  those  substances  be  held  contin- 
uously in  contact  with  the  protoplasm.  It  is  not  unlikely  that  any 
product  of  normal  katabolism  is  equally  disastrous  if  permitted  to 
remain.  Every  one  has  experienced  the  sensation  of  fatigue.  What 
is  the  peculiar  sensory  condition  present?  Undoubtedly  it  represents 
an  excess  of  normal  waste  material  acting  upon  sensory  nerve 
endings.  Every  student  of  physiology  is  aware  that  in  fatigue  a 
definite  toxic  substance  is  produced.  The  blood  serum  taken  from 
a  fatigued  animal  and  injected  into  the  vascular  system  of  one  in 
a  rested  condition,  will  produce  in  the  latter  every  symptom  char- 
acteristic of  a  fatigued  animal.  Influenza  produces  similar  symptoms 
and  Verworn  has  attempted  to  identify  the  two  conditions  or  at 
least  to  show  their  marked  similarity.  In  this  condition  there  is 
present  a  material  toxic  to  the  cell  and  irritant  to  the  nerve  terminal 
in  a  manner  similar  to  the  effect  of  the  sarcolactic  or  other  acid 
always  present  in  excess  in  overworked  muscle  tissue.  The  presence 
of  the  bacillus  causing  influenza  is  not  necessarily  a  detriment  to 
the  organism  but  in  many  cases  pathological  conditions  may  be 
caused  in  part  from  its  activity.  In  these  it  is  not  the  presence  of  the 
bacterium  merely  but  of  its  excretion  products  that  constitutes  the 
deleterious  influence.     Whether  it  be  a  toxalbumin  similar  in  kind 

33 


34  PRINCIPLES   OF    OSTEOPATHY 

to  that  produced  by  body  activity  remains  to  be  demonstrated. 
Sufficient  for  present  purposes  to  note  the  fact  that  the  material  is 
toxic  and  must  of  necessity  produce  cell  disorder  if  present  in 
sufficient  amount  and  for  a  sufficient  period  of  time.  Whatever  the 
source  of  the  toxic  material,  whether  it  comes  from  bacteria,  over 
exercise,  or  perverted  cell  metabolism,  it  is  immediately  a  possible 
cause  for  harm. 

Metabolism 

These  considerations  in  reference  to  faulty  metabolism  have  led 
many  into  error.  The  statement  is  made  that  the  cause  of  disease 
resides  in  the  metabolism  of  the  cell.  This  is  true  only  in  a  limited 
sense.  A  more  nearly  correct  statement  would  be  that  the  disease 
is  the  faulty  metabolism  of  the  cell.  It  remains  to  trace  the  faulty 
metabolism  to  its  source.  It  is  obvious  that,  theoretically,  numerous 
terms  of  stimuli  may  come  into  relation  with  the  cell  protoplasm 
to  modify  its  activity.  Mechanical,  thermal,  chemical,  electric, 
nervous  stimuli — all  are  known  to  affect  protoplasm.  But  in  every 
case  these  influences  must  be  brought  over  channels  that  connect 
cell  with  periphery  or  with  center.  For  the  cells  constituting  the 
organs  usually  involved  in  disorder  are  deeply  situated  in  an 
environment  of  comparative  quiet.  Mechanical  pressure  does  not 
act  as  a  serious  stimulus  because  that  pressure  is  constant.  Thermal 
conditions  are  unfavorable  for  producing  response  since  it  is  only 
a  sudden  change  that  is  an  efficient  stimulus.  Chemical  stimuli  only 
reach  it  through  the  medium  of  channels  which  transmit  fluid 
capable  of  performing  the  office  of  a  vehicle,  while  nervous  in- 
fluences are  similarly  carried  over  definite  pathways.  Nerve  im- 
pulses govern  blood  vessels  and  thus  indirectly  the  quality  of  the 
blood.  Nerves  are  dependent  upon  blood  for  their  nutrition.  The 
cell  is  thus  dependent,  not  only  upon  both  blood  and  nerve  supply, 
but  also  upon  a  proper  relation  between  both  of  these,  for  its 
proper  functioning.  Over  all  is  exercised  a  co-ordinating  power, 
seemingly  inherent  in  protoplasm  and  by  which  the  cell  is  main- 
tained in  balance  between  its  anabolic  and  katabolic  processes. 
Hence  so  long  as  the  channels  connecting  cell  with  periphery  and 
with  center  be  kept  free,  no  break  in  the  chain  of  events  constitut- 
ing the  metabolic  cycle  is  possible.  The  normal  hydrostatic  and 
osmotic  pi'essures  are  maintained  at  such  a  level  as  to  necessitate 


CAUSE  OF  THE  DISEASE  35 

correct  functioning  in  vital  selection.  Nutrient  materials  are  taken 
in  from  the  blood  with  ease  and  rapidity.  Waste  materials  are 
discharged  with  equal  facility.  Fatigue  cannot  long  persist  since 
a  growing  loss  of  irritability  necessitates  rest.  Bacterial  products 
though  present  in  the  blood  do  not  remain  long,  since  normal 
protoplasm  secretes  antitoxin  and  the  neutralized  substances  ex- 
creted. An  uninterrupted  nerve  influence  keeps  up  constantly  nor- 
mal chemical  and  vital  protoplasmic  changes.  Under  such  circum- 
stances the  cell,  vital  and  self-sufficient,  cannot  easily  go  wrong  in 
its  action. 

Circulation 

But  modify  the  conditions  associated  with  the  channels  of  inter- 
change and  note  the  result.  Changes  in  blood  supply  and  drainage 
permit  changes  in  osmotic  conditions  and  hence  changes  in  activity 
of  the  cell  selection  and  rejection;  lessened  cell  nutrition  and  cell 
regulation  result.  Metabolism  may  be  abnormal  from  changed 
nature  of  nerve  influence.  Undoubtedly  in  the  case  of  most  cells 
of  the  body,  their  activity  is  partly  under  the  control  and  co- 
ordination of  nerve  influence.  An  excess  of  that  influence  may  cause 
the  accumulation  of  the  katabolic  products  constituting  the  occasion 
for  fatigue.  This  means  that  the  nerve  initiates  a  too  rapid  trans- 
formation of  potential  energy  of  cell  protoplasm  into  kinetic  energy 
of  chemical  and  vital  activity.  This  additional  activity  further 
initiates  new  changes  immediate  and  remote  and  a  chain  of  events 
is  inaugurated.  A  deficiency  of  nerve  influence,  on  the  other  hand, 
permits  a  lowered  resistance  to  other  stimuli,  with  one  or  both  of 
two  efi'ects,  a  trophic  change  in  the  tissue  or  a  perverted  quality  of 
metabolism.  In  the  latter  case  the  complete  products  of  the  normal 
"metabolic  cycle"  are  not  formed  and  hence  various  types  of 
degeneration  may  follow. 

Structural  Causes 

How  are  these  interferences  produced?  Largely  by  changes  in 
structural  relations  of  those  tissues  least  subject  to  vital  control, 
such  as  connective  tissue,  especially  bone  and  ligament.  In  this 
connection  note  that  it  is  not  correct  to  state  that  the  lesion 
causing  the  disorder  is  a  lesion  of  the  cell.  The  unreduced  structural 
perversion  called  the  osteopathic  lesion  is  essentially  tissue  without 


36  PRINCIPLES  OF  OSTEOPATHY 

power  of  self-adjustment;  it  is  not  protoplasmic  but  consists  chiefly 
of  passive  intercellular  substance.  Why  is  bone  so  slow  to  yield  T 
Not  because  of  living  cells  in  bony  tissue,  for  they  are  probably 
as  self-adjusting  as  similar  protoplasmic  aggregations  in  other  tis- 
sues; but  because  incorporated  within  the  osseous  tissue  there  is 
a  predominant  amount  of  lime  deposits  which  give  to  the  bone  its 
unyielding  character,  and  which  have  no  powers  of  self -adjustment. 

In  ligamentous  and  other  connective  and  supporting  tissues  it  ie 
the  more  inert  intercellular  substance  that  constitutes  the  diffi- 
culty in  self -regulation  when  a  lesion  occurs;  hence  the  emphasis 
placed  upon  bony  and  ligamentous  lesions  in  relation  especially  to 
chronic  disorders. 

In  the  absence  of  the  abnormal  structural  conditions  suggested, 
any  failure  to  supply  the  blood  with  materials  from  which  the  cell 
claims  its  pabulum,  any  abuses  or  excesses,  must  have  deleterious 
effects  upon  the  cells  themselves.  But  such  effects  are  temporary 
unless  there  has  been  permanent  structural  injury,  for  as  soon  as 
any  cause  of  injury  has  been  removed,  repair  is  rapid  and  usually 
complete. 

Altogether  it  would  seem  that  the  cell  normally  present  in  the 
body  cannot  of  itself  cause  disease  either  in  itself  or  in  its  neighbors. 
Jt  is  inherently  healthy  and  is  incapable  of  harm  until  the  connec- 
tion between  it  and  its  blood  stream,  lymph  channels,  nerve  centers 
or  other  normal  relations  have  been  impaired.  Interference  with 
these  by  persistent  pressure  from  displaced  structures  or  by  accum- 
ulation of  fluid,  not  subject  to  vital  control,  constitutes  the  factor 
which  produces  or  maintains  disturbances  in  cell  metabolism. 


CHAPTER  Vm 

MAN  A  MACHINE 
The  Body  a  Physical  Mechanism 

It  was  stated  that  underlying  the  practice  of  osteopathy  there 
is  the  recognition  of  a  close  and  fundamental  relation  between 
structure  and  function.  Reference  was  made  to  the  fact  that  the 
human  body  in  structural  aspects  partakes  of  the  nature  of  a  definite 
machine,  the  operation  of  which  follows  definite  mechanical  laws. 
Its  cellular  arrangement  is  incidental,  but  is  advantageous  in  its 
relation  to  the  physical  support  of  so  large  a  mass  of  protoplasm, 
its  proper  and  perfect  nutrition,  and  its  differentiation  of  function. 

That  man  is  a  machine  is  an  assertion  trite  enough,  yet  one  that 
demands  some  consideration.  A  machine  is  an  instrument  by  which 
force  is  changed  in  direction  or  intensity,  the  change  being  associat- 
ed with  the  transformation  of  energy.  While  the  mechanic  employs 
a  vast  number  of  mechanisms,  yet  with  the  exception  of  certain 
electrical  appliances,  all  may  be  reduced  to  a  few  simple  machines, 
viz.,  the  lever,  the  pulley,  the  wedge.  Each  of  these  is  represented 
in  the  human  body.  Practically  every  action  of  the  voluntary 
muscles  is  dependent  upon  the  principal  of  the  lever.  When  one 
extends  his  forearm  he  does  so  by  the  use  of  a  lever  of  the  first 
class;  when  he  forces  his  body  from  a  wall  by  placing  his  hands 
against  it  the  lever  is  of  the  second  class ;  when  he  flexes  his  forearm 
he  employes  a  lever  of  the  third  class.  Borelli  and  Marey  in  their 
investigations  relating  to  the  action  of  the  locomotor  organs  have 
shown  by  mathematical  and  other  demonstration  the  nicety  of 
adjustment  of  those  organs  to  the  work  required  to  be  done,  em- 
phasizing thereby  the  purposefulness  of  the  peculiarities  in  body 
structure.  In  the  superior  oblique  muscle  of  the  eyeball,  in  the 
peroneus  muscle,  and  in  the  long  head  of  the  biceps,  are  represented 
the  pulley  action  by  which  the  direction  though  not  the  intensity 
of  the  force  is  changed.  In  the  "bag  of  waters"  at  parturition,  in 
peristaltic  action,  and  in  certain  factors  of  the  process  of  vomiting 
are  seen  illustrations  of  the  principle  of  the  wedge.  The  laws  of 
hydrostatics  and  hydrodynamics  are  made  use  of  in  numerous  eases. 

37 


38  PRINCIPLES  OF  OSTEOPATHY 

Pascal 's  law  of  fluid  pressure  is  at  the  basis  of  blood  distribution  and 
blood  flow;  capillary  attraction,  osmosis,  filtration  and  diffusion, 
play  no  inconsiderable  part  in  body  functioning ;  the  fenestra  rotun- 
dum  of  the  middle  ear  with  its  membranous  covering  is  a  provision 
for  the  law  of  fluid  incompressibility.  The  laws  of  air  pressure 
are  utilized  in  the  processes  of  respiration  and  circulation,  and  in 
giving  support  to  the  articulations  and  the  viscera. 

While  it  is  thus  recognized  that  man  is  a  machine,  the  term 
niechaijism  is  one  more  descriptive  of  the  real  condition,  in  that  the 
former  carries  with  it  by  association  the  idea  of  rigidity  and  un- 
yielding parts.  This  latter  is  obviously  not  a  peculiarity  of  a  living 
organism  in  which  continuous  change  is  characteristic.  Further, 
mechanism  involves  the  idea  of  complexity  which  is  noticeably 
characteristic  of  the  human  body.  But  whether  machine  or  mechan- 
ism, it  is  to  be  remembered  that  the  principles  operative  in  each  are 
in  large  part  similar  if  not  identical. 

A  Chemical  Laboratory 

The  body  is  not  merely  a  machine  by  reason  of  which  it  can 
produce  various  changes  in  the  nature  of  the  energy  with  which 
It  comes  into  relation;  and  through  the  operation  of  purely  physi- 
cal laws  that  are  possible  of  expression  through  the  arrangements 
of  its  numerous  parts  it  can  perform  the  function  of  a  physical 
laboratory.  It  is  in  addition  a  chemical  laboratory  the  capacities  of 
which  have  a  reach  that  is  entirely  beyond  the  artifice  of  man. 
Substances  are  formed,  torn  down  and  re-formed,  which  have  no 
counterpart  in  the  world  outside  of  organic  life,^  No  man  has  yet 
been  able  to  synthesize  living  proteid  from  the  inorganic  or  organic 
materials  at  his  command.  Even  in  those  syntheses  which  have  been 
made  artificially  they  were  first  secured  by  the  means  of  forces 
never  possibly  present  in  living  tissues,  such  as  high  temperatures, 
concentrated  and  destructive  acids,  alkalies  and  gases,  powerful 
electric  currents,  and  other  conditions  whose  very  presence  would 


^"The  power  of  the  living  cell  to  effect  chemical  changes  in  the  substances 
which  it  absorbs  is  most  incredible,  for  alizarin  blue,  one  of  the  substances 
whicli  Ehrlich  has  employed,  can  only  be  reduced  by  the  most  powerful  agents 
outside  the  body,  for  example,  by  boiling  with  caustic  potash  and  grape 
sugar,  and  yet  it  is  completely  reduced  within  the  living  body  by  the  liver 
and  by  the  cortical  substances  of  the  kidney,  and  is  rapidly  reduced  after 
(loath  by  the  heart,  liver  and  muscular  substance." — Brunton:  Introduction 
to    Modern    Therapeutics,   p.   96. 


MAN  A  MACHINE  39 

immediately  destroy  all  vital  processes.  More  recently,  many  of 
these  reactions  have  been  secured  by  means  of  inorganic  catalysts, 
by  unorganizd  enzymes  and  by  certain  chemico-physical  states  not 
yet  well  understood,  but  which  may,  conceivably,  be  associated 
with  the  vital  activities  of  tissues. 

We  may  take  the  living  tissue  and  analyze  it,  but  when  the 
analysis  begins  the  proteid  has  lost  its  life  essence.  What  remains 
we  may  analyze  and  determine  in  part  its  constituents.  We  may 
take  of  the  products  of  living  proteid  and  after  analysis  draw 
conclusions  as  to  the  original  living  tissue.  But  we  are  yet  in  the 
dark  as  to  the  fundamental  quality  in  the  chemical  nature  of  living 
protoplasm.  Even  the  complete  formula  for  the  dead  protoplasm 
defies  exact  statement.  Even  when  that  is.  once  accomplished  we 
shall  have  little  reason  to  hope  for  an  immediate  determination 
of  the  composition  of  the  living  tissue.  The  very  act  of  analysis 
destroys  life,  and  within  the  sacred  precincts  of  the  living  proteid 
molecule  we  may  not  go,  and  the  discovery  of  the  intimate  nature 
of  that  substance  must  continue  to  be  a  subject  for  speculation  and 
not  demonstration  so  long  as  we  can  anticipate. 

That  the  conditions  needful  for  chemical  action  are  strikingly 
present  in  the  human  organism  need  hardly  be  emphasized.  Suffice 
it  to  suggest  a  few  facts  that  call  attention  to  it.  The  body 
as  a  whole  is  over  sixty  per  cent,  water.  The  essential  living  part 
of  the  body,  the  protoplasm,  contains  a  sufficiently  greater  amount 
to  render  it  distinctly  fluid.  This  fact  is  of  fundamental  importance 
from  the  standpoint  of  chemical  possibilities.  That  it  is  fluid  rather 
than  solid  is  suggested  by  the  fact  that  it  flows  as  in  the  case  of  the 
streaming  process  noted  in  the  cells  of  certain  plants;  by  the  ten- 
dency which  the  white  blood  corpuscle  and  other  typical  protoplasm 
exhibits  to  assume  a  spherical  shape ;  and  the  further  tendency  of 
other  fluids  to  assume  that  shape  when  absorbed  within  an  environ- 
ment of  protoplasm  such  as  is  noticed  in  the  case  of  fat  droplets. 
Owing  to  this  fluid  nature  chemical  action  may  take  place  more 
efficiently  and  more  rapidly,  which  is  a  fact  of  considerable  value 
for  the  purpose  of  quick  response  to  stimuli  so  necessary  to  a 
complex  life.  Contained  within  this  fluid  material  are  found  a 
dozen  or  more  of  the  lighter  chemical  elements  held  in  rather  loose 
chemical  combination  so  that  when  materials  from  the  outside 
world    have    become    absorbed   into    the    protoplasmic    substance    a 


40  PRINCIPLES  OF  OSTEOPATHY 

rapid  change  of  atomic  and  molecular  association  is  readily  affected. 
In  another  section  reference  was  made  to  the  fact  that  of  the  ele- 
ments found  associated  with  protoplasm  a  few  are  of  fundamental 
importance,  namely,  the  oxygen,  the  hydrogen,  the  nitrogen,  and 
the  carbon.  A  few  others  seem  to  be  essential  but  perform  a  less 
important  role  in  metabolism,  while  still  others  in  special  forms 
may  be  present  or  absent.  The  proteid  material  found  in  the  body 
IS  in  large  part  what  is  spoken  of  as  combined  proteid.  Jaquet 
gives  the  following  formula  of  one  of  the  most  important  of  the 
combined  proteids,  namely,  haemoglobin,  which  suggests  the  extreme 
complexity  of  the  substance  and  the  infinite  possibilities  of  rear- 
rangement in  the  processes  of  vital  chemistry:  C^gg  H1203  ^i»ti 
Fci  'S3  Oais^  This  represents  but  one  of  a  large  number  of  the  com- 
bined proteids.  If  we  permit  ourselves  to  dwell  upon  the  resources 
from  which  the  body  chemist  may  draw  and  the  numerous  products 
that  are  continuously  formed  we  cannot  be  otherwise  than  astonished 
at  the  unerring  precision  and  nicety  of  adjustment  which  is  main- 
tained throughout  the  life  of  the  normal  individual. 

The  division  point  between  chemical  action  in  the  body  and  that 
dependent  on  other  forms  of  ^energy  is  not  a  definitely  determined 
one.  Yet  we  know  that  many  of  the  fundmental  facts  of  physiology 
are  largely  chemical  ones.  Proteid  foods  in  the  alimentary  canal 
are  acted  upon  by  the  pepsin  and  the  trypsin  and  reduced  to  simpler 
and  more  diffusible  forms  in  a  manner  seemingly  entirely  identical 
with  that  which  takes  place  outside  of  the  body.  The  oxygen  enter- 
ing the  blood  and  later  the  tissues,  forms  a  combination  with  carbon 
which  is  identical  with  oxidation  processes  wherever  found.  Hydro- 
gen and  oxygen  unite  to  form  water  in  a  manner  similar  to  its 
synthesis  elsewhere  so  far  as  can  be  determined.  Urea,  formed 
by  the  liver  cells  from  ammonia  and  carbon  dioxid  in  the  blood, 
is  in  all  likelihood  the  result  of  a  process  similar  to  its  formation  in 
the  chemist's  laboratory.  Thus  is  emphasized  the  fact  that  the  body 
organism  is  capable  of  chemical  possibilities  not  only  entirely  like 
those  outside  organized  life,  but  in  addition  surpasses  the  known 
laws  and  possibilities  of  laboratory  chemistry. 

Prom  the  above  considerations  may  be  drawn  several  important 
inferences.    Every  compound  not  present  as  such  in  the  food  mater- 

'Burton-Orpitz:     Physiology,  1920. 


MAN  A  MACHINE  41 

ials,  which  is  necessary  to  the  body  in  normal  functioning,  will  be 
formed  by  the  organism's  own  chemical  processes  if  the  elements 
are  present  in  suitable  chemical  combinations.  Iron  compounds 
have  for  long  been  the  staple  remedies  for  anemia.  In  this  disease 
there  is  a  deficiency  in  the  haemoglobin  of  the  red  corpuscles,  with 
or  without  a  deficiency  in  the  number  of  these  bodies  themselves. 
Iron  is  one  of  the  necessary  elements  for  hgemoglobin.  It  was 
assumed  that  by  the  administration  of  the  inorganic  iron  compounds 
the  deficiency  of  that  element  was  provided  for.  It  has  been  defin- 
itely proven  that  the  iron  thus  administered  passes  through  the 
body  practically  unchanged  and  unassimilated.  But  the  practice 
of  administering  the  iron  is  still  too  prevalent.  Note  the  fact: 
the  fault  is  not  one  of  a  limited  source  of  iron  but  a  limited  power 
of  assimilation  of  iron.  The  food  materials  of  an  ordinary  diet 
contain  enough  iron  as  well  as  other  elements  for  all  normal  func- 
tioning. Increa'Sing  the  amount  of  iron  even  though  it  may  be 
assimilable  in  such  form  as  it  is  given,  which  is  doubtful,  must  of 
necessity  fail  as  a  remedial  measure.  The  organism  builds  up  from 
the  food  materials  all  those  iron  compounds  necessary  in  the  com- 
position of  hgemoglobin.  It  has  recently  been  contended  that  arsenic 
in  small  amounts  is  a  constant  constituent  of  certain  of  the  tissues, 
and  from  this  was  derived  the  assumption  that  the  giving  of  arsenic 
in  certain  diseases,  long  a  thing  of  practice,  had  thus  found  its 
justification.  Reasoning  could  be  no  more  faulty.  The  argument 
against  iron  in  anemia  holds  equally  against  the  use  of  arsenic. 
In  both  of  these  cases,  if  a  deficiency  in  the  assimilation  of  the 
substance  be  the  real  condition,  then  the  logical  consideration  would 
be  the  determination  of  the  faulty  condition  of  the  part  which 
prevents  the  organism  itself  from  selecting  and  utilizing  those  sub- 
stances which  are  found  in  sufficient  abundance  in  the  blood. 

Another  important  deduction  is  this:  when  unusual  conditions 
arise  which  demand  unusual  compounds,  the  latter  are  formed, 
provided  the  necessary  elements  and  a  correct  adjustive  mechanism 
are  present.  Hemorrhage  is  self -limited  in  most  cases.  Why? 
Fibrin,  not  found  in  blood  under  ordinary  conditions,  is  immedi- 
ately formed  from  the  interaction  between  thrombin  and  fibrinogen 
which  are  present  either  actually  or  potentially  in  the  blood,  on 
exposure  of  the  latter  to  air  or  other  foreign  substance.  Thus  the 
clot  is  formed  and  further  hemorrhage  prevented.     Why  are  indi- 


42  PRINCIPLES    OF    OSTEOPATHY 

viduals  immune  from  certain  diseases?  In  some  cases  by  a  so  called 
natural  immunity  which  presents  elements  in  the  blood  and  tissues 
antagonistic  to  infective  agents.  In  other  cases  through  the  excess- 
ive activity  due  to  a  previous  attack  whereby  an  increase  in  the 
neutralizing  substance  was  brought  about.  What  is  the  source  of 
lactose?  It  is  a  sugar  found  only  in  connection  with  the  secretions 
of  the  mammary  glands,  generated  from  the  stimulus  associated 
with  the  pregnant  and  lactation  periods. 

Further  instances  might  be  supplied  but  the  point  is  sufficiently 
plain.  The  body  organism  by  virtue  of  its  ability  to  act  and  be 
acted  upon  is  continually  meeting  new  conditions  as  they  arise 
and  responding  in  a  manner  which  insures  its  continued  activity 
as  a  separate  and  self-sufficient  organism  in  a  world  of  contending 
organisms  and  inanimate  forces.  Through  its  physical,  chemical, 
and  vital  activities,  aided  by  a  favorable  medium,  .it  is  enabled  to 
maintain  successfully  an  identity  given  to  it  by  a  long  line  of  ances- 
tors and  at  the  same  time  yield  sufficient  variation  in  its  less  import- 
ant structural  and  functional  details  to  prevent  disintegration. 


CHAPTER  IX 

THE  ENERGY  OF  THE  BODY 

The  suggestion  that  man  is  a  machine  gives  rise  to  a  consid- 
eration of  the  nature  and  source  of  the  energy  that  must  of  neces- 
sity be  associated  with  the  machine.  As  already  indicated  one  of  the 
characteristics  of  the  machine,  whether  it  be  animate  or  inanimate, 
is  its  ability  to  convert  one  form  of  energy  into  another.  So  far 
as  is  at  present  known  no  creation  or  loss  of  energy  is  possible. 
This  law  of  the  conservation  of  energy  is  one  of  the  most  funda- 
mental and  significant  of  the  laws  made  emphatic  during  the  last 
century.  It  is  no  less  true  of  the  living  body  than  of  other  mech- 
anisms and  other  worlds,  that  the  various  manifestations  of  motion 
are  but  the  different  forms  into  which  the  one  universal  energy 
may  be  changed  from  time  to  time. 

Nature  of  Energy 

What  is  energy?  Authorities  differ  in  details,  but  it  is  agreed 
that  kinetic  energy  may  be  provisionally  considered  as  some  man- 
ifestation of  motion.  Dr.  Still  has  emphasized  the  triune  nature 
of  the  body  in  his  discussions  of  "matter,  motion  and  mind."  Mat- 
ter is  inert  in  so  far  as  it  may  be  independent  of  motion.  But 
matter  cannot  be  independent  of  motion  and  manifest  itself  to  the 
senses.  The  two  are  one  and  inseparable.  The  motion  of  an  atom 
is  an  integral  part  of  the  conception  of  an  atom.  As  soon  as  matter 
becomes  separate  from  motion  the  universe  as  such  must  cease  to 
exist.  We  know  that  appearances  are  continually  changing.  We 
know  that  change  is  a  law  of  nature.  And  change  is  only  possible 
through  the  numerous  forms  of  energy  that  are  associated  with 
the  substance  of  which  all  things  are  composed.  We  may  conceive 
of  mass  motion,  and  molecular  motion,  and  atomic  motion.  These 
are  in  all  likelihood  different  phases  of  the  same  great  energizing 
principle  which  lies  back  of  the  manifestation.  All  are  concerned 
with  the  one  inherent  property  of  all  matter — that  which  we  denom- 
inate energy. 

(Since  these  paragraphs  were  written,  our  understanding  of  this 

43 


44  PRINCIPLES  OF  OSTEOPATHY 

"great  energizing  principle"  has  been  somewhat  broadened  by 
investigations  into  the  relations  of  electrons,  the  constituent  parts 
of  atoms,  the  nature  of  etheric  radiations,  and  many  other  aspects 
of  the  physical  and  chemical  sciences.) 

It  has  been  said  that  energy  remains  the  same  in  essence.  How 
is  it  that  it  appears  so  different  under  different  circumstances? 
This  makes  necessary  a  consideration  of  a  corollary  to  the  proposi- 
tion that  energy  is  never  lost  or  created,  and  that  is,  that  there  is 
a  continuous  transformation  of  energy.  This  capacity  for  trans- 
formation depends  upon  the  circumstances  and  composition  of  the 
matter  with  which  the  energy  is  associated.  Any  mechanism  which 
is  able  to  cause  a  new  appearance  in  the  manifestation  of  energy 
is  a  transformer,  not  a  creator  of  energy.  The  human  body,  as  all 
living  bodies,  is  such  a  transformer.  The  proposition  may  be  illus- 
trated by  several  instances. 

Chemical  Action 

One  of  the  forms  which  energy  assumes  is  that  of  chemical 
action  which  may  be  considered  as  an  attraction  between  atoms. 
It  is  needless  to  do  more  than  to  call  attention  to  the  fact  that  body 
functioning  is  largely  dependent  upon  the  attraction  that  thus  ex- 
ists. The  source  of  such  energy  is  ultimately  from  the  external 
world,  i.  e.,  from  the  food  materials  taken  into  the  body  and  from 
the  potential  capacities  of  the  living  cell  which  were  transmitted 
to  it  from  its  parentage.  Of  the  latter  it  is,  as  yet,  necessary  to  as- 
sume an  inherent  governing  force  which  inaugurates  the  various 
clianges  of  a  chemical  nature  with  which  the  embryological  processes 
are  associated.  Such  changes  constitute  a  transformation  of  poten- 
tial into  chemical  energy.  But  the  chemical  energy  thus  initiated 
further  assists  cellular  activities  in  which  new  energy  is  shown,  and 
a  retransformation  appears.  The  food  materials  taken  into  the  ali- 
mentary canal  represent  immense  quantities  of  stored  chemical 
energy.  As  this  material  comes  in  contact  with  certain  other  sub- 
stances in  the  canal  which  are  the  product  of  other  cellular  action 
and  chemical  factors,  the  potential  energy  of  the  food  mass  becomes 
kinetic  in  the  liberation  of  new  chemical  action  and  heat.  The 
oxygen  taken  into  the  body  through  the  membrane  of  the  air  cell 
passes  into  the  blood,  is  carried  to  various  parts  of  the  body,  unites 
with  the  carbon  of  the  food  and  of  the  body  tissue,  and  in  the 


THE  ENERGY  OF  THE  BODY  45 

chemical  changes  thus  inaugurated  heat  is  set  free.  In  the  finer 
processes  of  assimilation  and  dissimilation  the  same  changes  and 
reverse  changes  are  produced  through  the  continuous  interaction 
of  the  chemical  and  vital  activity. 

Molecular  Relations 

There  is  a  cohesive  force  associated  with  body  action.  This  may 
be  spoken  of  as  molecular  attraction.  Every  molecule  seems  to 
have  an  attractive,  or  a  repulsive,  effect  on  every  other  molecule. 
This  is  true  whether  the  substance  in  or  of  the  body  be  solid,  fluid, 
or  gas.  The  constant  intermixing  of  the  fluids  of  the  body  in  the 
processes  of  diffusion  and  osmosis  presents  opportunity  for  varying 
relations  between  the  molecules  of  the  different  substances.  By 
virtue  of  this  action  a  continuous  interchange  between  parts  of  the 
body  becomes  possible,  and  considering  the  fact  of  protoplasmic 
continuity  it  becomes  doubly  significant  as  a  factor  in  body  meta- 
bolism. The  difference  in  gaseous  pressures  between  the  oxygen 
of  the  air  in  the  alveoli  and  that  in  the  blood  explains  in  part  the 
presence  of  oxygen  in  the  blood;  the  chemical  attraction  of  hemo- 
globin for  oxygen  is  also  important.  Similarly  the  excess  of  the 
carbon  dioxid  in  the  blood  with  reference  to  the  amount  in  the 
lung  spaces  provides  a  means  for  excretion  of  the  noxious  gas.  In 
the  process  of  molecular  action  and  interaction  new  conditions  fav- 
orable to  different  atomic  affinities  arise  and  new  compounds  are 
constantly  produced. 

Gravitation 

The  energy  of  gravitation  while  not  strikingly  operative  in 
the  body  is  responsible  for  certain  actions  that  there  take  place. 
This  energy  may  be  referred  to  as  the  attraction  between  masses, 
and  while  it  undoubtedly  exists  in  the  case  of  different  masses 
of  the  body  tissue  it  is  insignificant  as  compared  to  the  attrac- 
tion between  the  body  and  the  earth.  In  this  connection  it  is 
interesting  to  note  the  fact  that  the  urinary  apparatus  of  the  human 
body  is  so  situated  as  to  take  advantage  of  gravitation,  and  by 
virtue  of  this  fact  alone  the  kidneys  are  in  large  part  constantly 
drained  of  their  excretions;  while  in  most  of  the  lower  animals 
gravitation  is  made  use  of  in  the  discharge  of  excretions  from  the 
body.    Molecular  and  chemical  movements  occur  in  opposition  to  the 


46  PRINCIPLES  OF  OSTEOPATHY 

force  of  gravitation  with  a  consequent  production  of  new   forms 
of  energy  such  as  heat  and  electric  action. 

Friction 

The  mechanical  energy  of  pressure,  friction,  and  change  of 
shape  associated  with  the  different  parts  of  the  same  substance 
are  very  manifest  in  the  body  and  in  its  relations  to  the  external 
world.  By  virtue  of  the  continuous  movement  of  the  body  parts 
and  the  movements  associated  with  environment,  pressures  and 
friction  occur  with  the  resulting  liberation  of  heat  and  other  forms. 
The  friction  of  the  blood  upon  the  vessel  walls  accounts  in  part 
for  the  resistance  to  the  blood  flow  which  is  so  necessary  to  a  normal 
blood  pressure.  This  friction  invariably  produces  additional  changes 
in  form,  and  as  a  result  heat  and  electric  and  chemical  action 
appear.  The  mechanical  pressures  of  external  matter  and  internal 
matter  upon  nerve  terminals  and  less  responsive  protoplasm,  pro- 
duces impulses  which  are  nervous  or  muscular  in  character,  either 
directly  or  through  an  intermediate  chemical  energy  which  is  in 
turn  converted  into  a  nerve  impulse.  The  latter  acting  upon  the 
stored  materials  in  the  nerve  cell  body  is  rechanged  into  chemical 
and  vital  energy  which  will  thence  further  the  chain  of  action. 
Mechanical  energy  acting  in  the  nature  of  a  stimulus  is  of  prime  im- 
portance to  the  osteopath.  For  it  is  largely  through  the  influence 
of  pressures  that  he  is  able  to  explain  the  various  effects  from  me- 
chanical displacements  of  tissues  constituting  the  lesion  which  is 
the  most  important  cause  of  disease. 

Heat 

In  a  special  kind  of  molecular  movement  is  seen  another  form 
oi  energy  with  which  the  body  is  associated  and  which  is  denom- 
inated thermal  energy.  This  is  spoken  of  as  a  molecular  vibration 
the  increase  of  which  explains  the  condition  of  a  rising  temperature, 
the  total  absence  of  which  constitutes  the  absolute  zero  point.  That 
a  certain  heat  level  is  necessary  to  body  functioning  is  evident  not 
only  from  experimental  observation  but  from  the  known  remarkable 
apparatus  present  in  man  which  maintains  that  level  in  spite  of  a 
fluctuating  temperature  of  environment.  This  form  of  energy  is 
derived  to  some  extent  directly  from  the  external  world  through 
the  medium  of  radiation  from  the  sun  and  other  warm  bodies,  and 
from  the  materials  taken  in  through  the  alimentary  and  respiratory 


THE  ENERGY  OF  THE  BODY  Al 

tracts  in  the  form  of  warm  food  and  air;  but  in  large  part  the  heat 
energy  is  indirectly  derived  from  chemical  energy  the  source  of 
which  has  been  already  indicated.  Practically  every  chemical  action 
is  associated  with  the  liberation  of  heat,  although  in  most  anabolic 
processes  the  consumption  of  heat  is  in  excess  of  its  liberation. 
Of  the  chemical  actions  concerned  with  the  liberation  of  heat 
oxidation  processes  are  by  far  the  most  important.  The  amount  of 
oxygen  consumed  in  the  course  of  twenty-four  hours  amounts  to 
700  grams  or  nearlj^  twenty  quarts  per  hour.  This  is  suggestive 
as  indicating  the  immense  amount  of  exidation  that  takes  place  in 
the  body.  While  it  is  thus  true  that  the  heat  is  in  large  part  derived 
from  chemical  action  together  with  that  resulting  from  mechanical 
energy  of  friction  and  movement,  it  is  also  true  that  a  transformation 
back  into  chemical  and  mechanical  energy  takes  place  to  an  extreme 
degree.  One  chemical  change  liberates  energy  in  the  form  of  heat. 
This  heat,  by  furnishing  a  normal  medium  initiates  new  chemical 
change,  and  is  in  other  eases  perhaps  converted  directly  into  mus- 
cular and  other  movement.  Throughout  the  various  metabolic  pro- 
cesses these  continuous  transformations  are  manifest. 

Light 

Photic  energy  is  essential  to  life  processes.  Light  has  been 
defined  for  lack  of  more  definite  knowledge  as  ether  vibration. 
This  vibration  is  ultimately  essential  to  all  life  processes.  The  chief, 
if  not  the  only  source  of  the  synthesis  of  proteid,  carbohydrate,  and 
fat  is  the  cell  of  the  living  organism.  From  the  plant  the  animal 
gets  its  food  material  ready  made.  But  in  order  that  the  plant 
shall  be  able  to  effect  this  synthesis  light  is  necessary.  Through 
some  power  seemingly  associated  with  the  chlorophyll  bodies  the 
plant  is  enabled  to  utilize  sunlight  in  the  chemical  process  concerned 
in  the  formation  of  foods  from  inorganic  materials.  But  it  is  not 
alone  in  this  indirect  way  that  light  is  essential  to  animal  life,  for 
observation  shows  that  individuals  living  in  an  environment  of 
greater  or  less  deprivation  of  light  become  abnormal  in  their  func- 
tioning. This  fact  suggests  the  necessity  for  looking  to  the  environ- 
ment of  the  individual  for  the  preservation  of  normal  health,  and 
from  this  fact  has  arisen  the  light  cure  by  which  it  was  hoped  to 
overcome  disease  conditions  through  an  excess  of  the  energy,  a 
certain  amount  of  which  is  essential.     An  excess  of  any  force  or 


48  PRINCIPLES  OF  OSTEOPATHY 

laetor  is  never  logical  as  a  method  of  cure.  That  an  excess  of  light 
is  deleterious  there  is  sufficient  evidence  to  show.  Ordinary  sunburn 
in  fair  skinned  individuals  is  a  pathologic  condition  as  also  are  the 
burns  from  X-ray  applications.  Individuals  working  in  factories 
where  light  is  generated  or  in  other  conditions  where  an  excess  of 
light  is  present  suffer  from  various  forms  of  cutaneous  and  other 
disorders. 

Light  is  further  a  normal  stimulus  for  the  function  of  sight.  In 
this  case  the  ether  vibration  coming  into  relation  with  the  pigment- 
ary layer  of  the  retina  is  transformed  into  chemical  energy  which 
influences  nerve  terminals  and  which  in  turn  results  in  the  definite 
subjective  sensation.  Whether  in  the  human  body  light  is  produced 
from  transformation  of  other  known  forms  remains  to  be  proven. 
In  the  ease  of  certain  of  the  lower  and  especially  of  marine  animals, 
chemical  action  or  other  energy  is  quite  appreciably  transformed 
into  light. 

Electricity 

Electric  energy  is  undoubtedly  associated  with  a  large  number 
oi  body  processes.  In  the  experimental  laboratory  it  can  be  shown 
that  both  chemical  and  mechanical  energy  may  be  transformed 
into  electricity.  It  is  probable  that  similar  conditions  in  the  case 
of  the  living  organism  are  responsible  for  the  electrical  manifest- 
ations known  to  be  present.  It  is  known  that  in  conditions  of  act- 
ivity and  of  pathology  a  difference  in  electric  potential  exists  in 
muscle  such  that  the  active  and  the  resting  state  are  electrically 
opposite  in  sign,  which  is  also  true  of  the  normal  and  the  injured 
tissue.  This  becomes  of  special  interest  in  view  of  the  recent  in- 
vestigations into  electro-chemistry.  The  investigation  into  the 
electric  conditions  of  the  body  has  only  begun  and  the  further 
results  are  awaited  with  much  interest.  Dr.  Still  continually  as- 
sumes the  presence  in  normal  as  well  as  abnormal  conditions,  of  a 
force  of  an  electric  or  magnetic  nature,  and  no  demonstration  to 
the  contrary  has  yet  shown  that  he  is  wrong,  while  what  experi- 
mental evidence  is  available  suggests  that  he  is  correct.  The  fact 
that  such  currents  exist  has  given  rise  to  numerous  attempts  to 
make  use  of  the  fact  in  a  therapeutic  way,  but  thus  far  electro- 
therapy has  proven  as  unsatisfactory  as  the  drug,  and  for  the  reason 
that  the  electrical  conditions  of  the  living  organism  still  remain 
far  outside  of  human  understanding. 


THE  ENERGY  OF  THE  BODY 


49 


Nerve  Energy 

With  reference  to  nerve  energy,  little  can  be  said.  Its  funda- 
mental importance  is  obvious  and  will  be  continually  referred  to. 
What  it  is  we  know  not.  It  may  be  measured  in  its  rapidity,  it 
may  be  judged  by  its  effect.  AVhether  it  be  electrical  or  chemical 
or  neither  we  can  not  at  present  say.  Mechanical  force,  chemical 
action,  light — all  may  influence  its  action  and  assist  in  co-ordinating 
its  impulses.  It  is  unique  among  the  body  forces  and  to  the  phy- 
sician presents  a  most  interesting  field  of  study.  When  its  ultimate 
nature  is  once  known  and  its  manifestations  and  variations  under- 
stood, much  will  be  done  toward  explaining  the  numerous  facts  of 
body  functioning  and  a  long  stride  will  have  been  taken  toward 
the  solution  of  many  vexed  problems  in  osteopathic  practice. 

Energy  Balance 

In  connection  with  the  above  considerations  the  following  table 
modified  from  Hall 's  Physiology  is  suggestive.  Note  that  the  energy 
of  the  body  finally  is  given  off  largely  if  not  entirely  in  the  form 
of  heat.  Owing  to  the  fact  that  the  latter  is  fairly  subject  to  meas- 
urement, approximations  of  energy  expenditure  can  easily  be  de- 
termined. 

Balance  Sheet  of  Energy  for  Man  at  Light  Work. 


Income: 

Proteids    110  grams  at    400  calories 

Pats  100  grams  at  9400  calories 

Carbohydrates  400  grams  at  4180  calories 

Expenditure : 

Mechanical  work  reduced  to  calories 

Excreta  loss  (1900  grams) 

Warming  of  inspired  air 

Evaporating  660  grams  perspiration. 

Evaporating  330  grams  H2O  from  lungs 

Radiation  and  conduction  from  skin 


Inc.  in  Cal. 

440,000 

940,000 

1,672,000 


3,052,000 


Exp.  in  Cal. 


500,000 

47,500 

84,500 

384,120 

192,600 

1,843,280 


3,052,000 


Thus  far  the  fact  has  been  emphasized  that  energy  in  various 
forms  is  fundamental  to  the  life  processes.  It  should  be  understood 
that  in  some  forms  of  energy  it  may  exist  either  as  potential  or 
kinetic,  as  latent  or  active,  and  that  these  are  interchangable.  The 
combination  of  the  molecules  and  atoms  in  foodstuffs  represents 
potential  energy,  which,  on  coming  into  relation  Mith  certain  en- 
vironments furnished  by   the  body,  is  converted  into   the  kinetic 


50  PRINCIPLES  OF  OSTEOPATHY 

energy  of  chemical  action  and  heat.  The  free  molecule  of  oxygen 
ID  the  plasma  of  the  blood,  by  virtue  of  its  chemical  affinities  has 
the  power  to  unite  with  carbon  and  other  elements  and  substances 
with  the  transformation  into  the  kinetic  energy  of  chemical  action 
and  heat.  The  stored  glycogen  and  related  compounds  in  the  pro- 
toplasm of  muscle  substance  represent  potentially  the  activity 
that  becomes  manifest  as  mechanical  energy  on  the  application  of 
a  stimulus.  The  stretched  condition  of  the  aortic  wall  immediately 
following  the  systolic  discharge  is  potential  energy  which  immedi- 
ately becomes  active  in  a  recoil  through  its  elastic  property. 

Summary 

Summarizing  the  foregoing  and  making  a  definite  application, 
it  may  be  stated  that  a  normal  condition  of  health  is  dependent  on 
a  proper  co-ordination  of  energies,  and  that  disease  represents  a 
condition  of  living  matter  such  that  inco-ordination  results.  If  the 
nature  of  muscle  tissue  is  such  that  its  potential  energy  requires 
an  excess  of  stimuli  to  be  converted  into  a  kinetic  manifestation, 
then  abnormality  exists.  If  a  nerve  cell  body  is  in  a  state  of  hyper- 
excitability  due  to  disorders  of  its  nutrition,  the  condition  is  a  too 
ready  response  to  a  stimulus  with  resulting  change  to  a  kinetic 
torm.  Further,  these  transformations  all  represent  normal  stimuli 
to  body  action.  Life  processes  consist  largely  of  response  to  the 
stimuli  of  a  continuous  stream  of  impulses  that  pass  by  countless 
different  tracts  from  periphery  to  center.  If  the  external  or  en- 
vironmental changes  are  too  rapid  or  intense  for  a  normal  response, 
or  if  the  organism  is  in  a  condition  which  prevents  a  sufficiently 
rapid  assimilation  of  energy  and  its  proper  conversion,  disorder 
must  result.  In  the  former  the  fault  lies  with  the  environment  and 
is  a  cause  of  disease  which  in  another  section  is  classified  as  an 
abuse  of  function.  In  the  latter  the  condition  will  usually  be  found 
dependent  on  a  condition  of  impaired  structure  which  modifies  the 
processes  necessary  to  a  proper  co-ordination  of  energies.  When 
through  lesion  to  the  digestive  apparatus  a  deficiency  of  gastric 
secretion  exists,  the  balance  between  the  potential  energy  of  the 
food  and  that  of  the  gastric  juices  is  disturbed.  Hence  disturbed 
chemical  transformation  results.  Through  a  fault  of  the  organic 
structure  the  heat  regulation  mechanism  may  become  deranged 
and  an  excessive  chemical  action  with  heat  liberation  result  with 


THE   ENERGY  OF  THE  BODY  51 

a  consequent  rise  in  body  temperature.  This  rise  in  temperature 
furnishes  the  occasion  for  further  excessive  transformation  and  a 
chain  of  effects  may  follow.  An  injury  to  a  muscle  initiates  chem- 
ical changes  excessive  in  kind  or  degree,  and  a  considerable  dif- 
ference in  electrical  potential  is  produced,  as  well  as  other  import- 
ant changes.  These  various  effects  of  the  injury  ultimately  result 
in  infiamraatory  changes,  and  these,  in  turn,  tend  to  bring  about 
a  return  to  normal  structure  and  function.  If  the  injury  is  not 
too  severe,  and  if  other  conditions  of  the  body  are  normal,  recovery 
may  be  almost  or  quite  complete.  The  continued  absence  of  any 
normal  stimulus  from  environmental  change,  such  as  light,  results 
in  a  loss  of  energy  transformation  which  is  dependent  upon  such 
stimuli,  and  a  general  weakness  in  consequence. 

With  the  action  and  interaction  of  matter  and  motion,  then,  and 
all  under  the  superintendency  of  a  guiding  force,  call  it  mind, 
vitality  or  what  not,  the  normal  body  metabolism  will  be  main- 
tained in  harmony  with  itself  and  with  its  environment.  Through 
long  ages  the  organism  has  been  subjected  to  certain  environmental 
conditions  by  which  it  has  become  adapted  to  all  ordinary  and  to 
numerous  extraordinary  circumstances.  In  such  adaptations  of 
energy  is  seen  one  of  the  most  remarkable  facts  of  living  tissue. 


CHAPTER  X 

BODY  FUEL 

The  principal  source  of  the  energy  of  the  organism  is  the  food 
materials.  It  is  manifest  that  for  a  proper  transformation  and 
utilization  of  energy  there  must  be  a  sufficient  quantity  and  quality 
of  the  food  to  be  disintegrated  to  yield  the  necessary  forms.  As 
an  engineer  insists  on  a  good  quality  of  the  fuel  as  a  prerequisite 
to  a  full  capacity  in  the  performance  of  his  engine,  so  the  human 
engine  must  be  supplied  with  materials  appropriate  to  its  needs. 
From  analysis  of  the  body  substance  and  from  experimental  obser- 
vation it  has  been  determined  that  there  are  certain  organic  and 
inorganic  materials  which  are  essential  to  normal  body  functioning. 
Among  the  former  are  proteids,  carbohydrates  and  fats;  among 
the  latter,  water  and  several  salts,  more  especially  sodium  chloride. 
Three  or  more  substances  of  a  nature  not  yet  well  understood, 
called  vitamines,  are  also  essential  to  the  maintenance  of  good 
health.  Numerous  other  salts  are  found  in  body  tissues  but  are 
present  in  sufficient  abundance  in  the  organic  foodstuffs  to  make 
it  unnecessary  to  supply  additional  material.  Indeed,  evidence  is  ac- 
cumulating to  show  that  except  in  the  form  of  these  complex  organic 
substances  these  various  inorganic  salts  will  not  be  assimilated. 
Bunge,  in  speaking  of  the  value  of  lime  salts  makes  this  interesting 
observation:  "Lime  is  found  combined  in  organic  substances  in 
food;  it  is  therefore  irrational  to  prescribe  lime  for  children  in 
the  form  of  inorganic  compounds.  In  medical  practice  rickety 
children  are  constantly  being  ordered  a  couple  of  teaspoons  of  lime 
water.  This  is  useless  because  the  amount  ordered  is  far  too  small. 
A  saturated  solution  of  lime  contains  less  than  cow's  milk.  In  a 
pint  of  cow's  milk  I  found  1.7  grm.  CaO;  a  pint  of  lime  water 
contains  only  1.3  grm.  CaO."^  The  legitimate  deduction  is  that 
two  teaspoonfuls  of  cows'  milk  would  be  the  better  prescription! 
It  is  true  that  the  addition  of  lime-water  to  cow's  milk  forms  a 
basic  calcium  caseinate  which  cannot  be  acted  upon  by  rennin; 
thus  the  usual  tough  curds  of  cow's  milk  are  avoided.    It  is,  how- 


^Bunge:    Physiologic  and  Pathologic  Chemistry. 

62 


BODY  FUEL  53 

ever,  very  probably  true  that  this  action  interferes  with  the  nutrir 
tious  qualities  of  the  milk,  and  that  the  use  of  limewater  for  this 
purpose  is  harmful  to  the  child. 

The  function  of  the  inorganic  salts  is  in  large  part  the  regulation 
of  the  medium  in  which  organic  foods  may  be  stored,  transported 
and  assimilated.  Thus  Thompson  suggests  the  following  functions: 
'To  regulate  the  specific  gravity  of  the  blood  and  other  fluids  of 
the  body;  to  regulate  the  chemical  reaction  of  the  blood  and  the 
various  secretions  and  excretions;  to  preserve  the  tissues  from  dis- 
organization and  putrefaction;  to  control  the  rate  of  absorption  by 
osmosis;  to  enter  into  the  permanent  composition  of  certain  struc- 
tures, especially  the  bones  and  teeth;  to  enable  the  blood  to  hold 
certain  materials  in  solution;  to  serve  special  purposes,  such,  for 
example,  as  the  influence  of  sodium  chloride  on  the  formation  of 
hydrochloric  acid,  and  that  of  lime  salts  in  favoring  coagulation 
of  the  blood."' 

Water 

Water  is  an  absolute  essential  and  must  be  taken  in  greater 
quantity  than  is  present  in  the  solids  of  an  ordinary  diet.  Its  func- 
tions are  largely  secondary  to  those  of  the  organic  foods  but  none 
the  less  essential.  The  very  fact  that  about  sixty  per  cent,  of  the 
body  is  water  indicates  its  great  value.  Attention  was  called  to 
the  fact  that  the  essential  life  substance — protoplasm — is  largely 
fluid,  and  for  specific  purposes.  This  fluidity  is  dependent  on  the 
presence  of  water.  The  following  may  be  enumerated  as  the  more 
important  uses  of  water  to  the  body  organism:  solvent,  diluent, 
medium  for  transportation,  stimulant,  and  as  a  thermolytic  agent. 
Unquestionably  there  are  individuals  who  take  less  water  than  is 
essential  to  a  normal  functional  and  structural  condition. 

Proteids  are  the  most  essential  of  the  organic  substances.  It  has 
oeen  shown  by  Pfluger  and  others  that  in  case  of  the  dog,  of  the 
organic  foods  proteid  alone  is  sufficient  to  maintain  life,  Avhile  the 
absence  of  proteid  material  in  the  food  is  immediately  disastrous  to 
normal  function  and  soon  results  in  death.  In  general  the  statement 
is  true  that  proteids  are  the  tissue  builders  while  carbohydrates  and 
fats  are  energy  producers,  and  are  oxidized  with  the  liberation  of 


^Thompson:     Practical  Dietetics. 


54  PRINCIPLES  OF  OSTEOPATHY 

heat.  In  the  absence  or  deficiency  of  the  latter  two,  proteid  may  be 
converted  into  sugars  and  fats.  In  addition  to  these  comparatively 
simple  requirements,  vitamines  and  other  substances,  apparently  not 
either  tissue-builders  or  energy-providers,  are  essential  to  normal 
nutrition.  The  exact  place  of  these  substances  in  bodily  economy 
is  not  yet  (1922)  well  understood. 

Metabolism 

With  the  finer  processes  of  metabolism  we  are  of  necessity 
much  in  ignorance.  What  takes  place  in  the  transformation  from 
non-living  to  living  proteid  cannot  be  known  except  in  the  more 
gross  details.  This  is  undoubtedly  true,  that  only  those  substances 
which  are  concerned  in  tissue  building,  secretion,  and  energy  trans- 
formation will  be  permitted  to  remain  in  association  with  the  living 
piotoplasm.  In  this  connection  Dr.  C.  M.  T.  Hulett  has  emphasized 
the  fundamental  fact  when  he  says,  "The  chain  of  events  in  meta- 
bolism is  a  closed  chain  and  into  this  metabolic  cycle  no  substances 
but  those  that  serve  as  food  can  ever  enter.  Material  not  suitable 
for  its  upbuilding  cannot  be  imposed  upon  living  substance.  It  will 
take  in  only  food  elements  and  only  such  quantity  of  those  as  its 
needs  determine,  without  regard  to  the  supply  which  might  be 
available.  The  only  way  in  which  other  substances,  as  drugs,  can 
become  incorporated  with  living  substance  is  by  destroying  it.  Acids 
and  poisons  unite  with  it  in  that  way.  The  constituent  events  of 
the  metabolic  cycle  do  not  follow  each  other  in  a  single  line  but 
in  manj'^  lines.  Pfluger  has  emphasized  the  importance  of  the  poly- 
merization of  the  proteid  molecule  in  growth — assimilation,  in  living 
substance,  in  which  the  simple  molecule  takes  in  from  the  materials 
of  the  environntent,  atoms  of  food  elements,  attaching  them  to  itself 
until  it  becomes  a  polymeric  molecule.  It  then  breaks  down  into 
simple  molecules,  each  of  which  repeats  the  process  for  itself,  again 
and  again,  forming  in  that  way  numbers  of  chains  of  many  similar 
links.  Dissimilation  is  the  reverse  of  this  process,  the  end  products 
being  principally  water,  carbon  dioxide,  and  urea.  The  successive 
chemical  reactions  in  each  chain  or  line  have  been  compared  to 
explosions  on  account  of  the  great  lability  of  the  compounds.'" 

Monrnal   of  the   American  Osteopathic   Association,   Nov.,   3901. 


BODY  FUEL  55 

Selection 

By  the  process  of  selection  which  is  a  characteristic  attribute 
of  living  protoplasm,  every  particle  of  the  latter  and  every  normal 
cell  takes  or  rejects  the  materials  furnished  to  it  by  the  blood 
or  lymph.  In  a  similar  manner  it  throws  out  from  its  substance 
into  the  blood  or  lymph  every  material  that  is  of  no  further  use 
to  its  functioning.  This  is  true  of  the  substances  that  are  formed 
from  cell  katabolism  but  is  usually  true  also  of  those  foreign  ele- 
ments which  have  temporarily  gained  access  to  the  protoplasmic 
substance.  In  order  that  the  two  processes — selection  of  food  ma- 
terials and  the  rejection  of  waste — may  be  correctly  balanced  the 
medium  for  transportation  must  be  normal  in  kind  and  quality. 
The  lymph  must  contain  sufficient  available  material  from  which 
the  cell  may  select  and  must  be  in  such  a  normal  condition  of 
osmotic  pressure  and  chemical  activity  as  to  offer  no  serious  hin- 
drance to  the  exchange  of  waste  for  nutritive  substances.  This 
manifestly  depends  on  a  normal  condition  of  the  blood  both  with 
reference  to  quality  and  quantity.  Since  the  blood  itself  is  man- 
ufactured within  the  body,  from  materials  delivered  from  the  food, 
the  necessity  for  a  proper  diet  becomes  at  once  apparent. 


Reserves 

It  does  not  follow  from  the  above  considerations  that  every 
change  in  the  dietary  conditions  will  immediately  or  remotely 
produce  a  disturbance  in  the  protoplasmic  exchange.  For,  note 
that  there  are  large  possibilities  of  reserve  supplies  between  the 
cell  and  the  digestive  tract.  The  cell  itself  is  capable  of  carrying 
on  its  functioning  for  an  appreciable  time  even  though  the  blood 
be  totally  removed.  This  is  true  because  it  is  a  function  of  the 
cell  to  store  an  excess  of  food  not  immediately  needed.  In  every 
cell  under  ordinary  conditions  there  are  fat  droplets,  glycogen,  and 
other  reserves  which  in  addition  to  its  own  substance  will  be  drawn 
upon  as  the  needs  require.  In  the  lymph  and  blood  and  in  the  inter- 
cellular tissues  there  are  immense  quantities  of  stored  material. 
The  liver  stores  glycogen  abundantly.  The  fat  of  the  body  provides 
a  great  reservoir  of  potential  energy.  This  explains  the  fact  that 
the  organism  may  fast  for  weeks  with  little  impairment  of  function 


56  PRINCIPLES  OF  OSTEOPATHY 

though  there  will  be  an  appreciable  loss  of  substance,  chiefly  of 
those  structures  and  organs  which  are  not  immediately  necessary 
to  life. 

Diet 

What  are  the  essentials  in  a  diet?  The  science  of  dietetics 
is  still  in  a  condition  of  chaos.  Analysis  of  the  body  tissues  and 
secretions  have  thrown  some  light  on  the  problem.  Note  this 
fact:  the  chemical  composition  of  a  foodstuff  is  not  a  sufficient 
criterion  for  judgment  as  to  its  value  to  the  organism.  If  this 
were  the  case  the  food  supply  of  the  world  would  become  a  question 
of  laboratory  synthesis.  The  various  elements  must  be  in  a  definite 
condition  of  combination.  Further,  not  all  combinations  seemingly 
alike  in  their  various  characteristics  are  equally  available  to  the 
organism.  Starch  and  cellulose  are  similar  in  composition  but  the 
latter  is  nearly  indigestible.  Various  of  the  prepared  foods,  while 
containing  all  the  elements  and  compounds  in  proper  proportion, 
have  been  found  deficient  in  their  nutritive  value.  The  condensed 
foods,  peptonized  and  otherwise  predigested  foods,  are  not  suitable 
for  ordinary  conditions.  The  decrying  of  white  flour  and  extolling 
the  whole  wheat  variety  was  the  fashion  among  the  dietarians  a 
few  years  back.  Chemical  analysis  had  shown  that  the  whole 
wheat  contained  the  essential  organic  foodstuffs  in  more  nearly 
a  correct  proportion  than  did  the  white.  Yet  analysis  of  the  feces 
shows  that  the  proteid  in  the  husks  and  outer  part  is  much  less 
available  and  hence  in  large  part  of  no  use  to  the  organism  except 
as  a  stimulant  to  peristalsis.  The  vitamines,  whose  nature  is  not 
yet  known  (1922)  are  essential  to  growth  and  to  health. 

With  the  average  diet  available  to  the  ordinary  American  the 
organism  is  amply  able  to  extract  sufficient  of  the  nutritive  prin- 
ciples to  maintain  bodily  vigor.  Statistics  with  reference  to  differ- 
ent people  and  different  climates  are  illuminating  more  in  that 
they  show  that  what  is  chemically  a  very  deficient  diet  is  actually 
and  physiologically  a  very  sufficient  one.  The  Esquimaux  with  his 
tallow  and  the  Chinaman  with  his  rice  do  not  show  sufficient  differ- 
ences from  those  subsisting  on  a  more  varied  diet — explainable 
alone  from  dietetic  conditions — to  make  it  a  safe  rule  to  rely  upon 
chemical  analysis  alone  for  judgment  of  food  values. 


BODY  FUEL  57 

Proteid  Requirements 

Well-nourished  nations  eat,  on  an  average,  about  one  hundred 
grams  of  proteid  foods  each  day  for  each  grown  person.  It  has 
been  shown  experimentally  that  a  grown  man  can  do  active  work, 
and  remain  in  nitrogen  equilibrium  and  in  good  weight  and  good 
health,  upon  a  diet  containing  one-third  of  this  amount.  It 
has  been  supposed  by  many  recent  authors  (1922)  that  protein 
extravagance  may  lead  to  renal,  hepatic  and  intestinal  disturbances, 
and  to  various  types  of  toxemia.^ 

On  the  other  hand,  there  is  great  danger  that  in  reducing  the 
consumption  of  proteid  foods,  and  especially  in  reducing  the  variety 
of  proteids  used,  there  may  be  serious  reduction  of  the  factors  of 
safety.  Under  the  experimental  conditions,  men  are  not  subjected 
to  undue  strains,  nor  to  infections,  nor  to  emotional  or  other  con- 
ditions of  stress  such  as  are  inevitable  in  ordinary  life.  A  broader 
study  of  entire  peoples  or  families,  especially  since  the  Great  War, 
shows  rather  distinctly  that  any  constant  and  marked  deviation 
from  the  proteid  intake  of  about  100  grams  per  day  per  grown 
person  is  associated  with  diminished  resistance,  diminished  men- 
tality and  enthusiasm,  and  increased  tendencies  to  toxemias,  renal 
and  hepatic  diseases,  the  very  diseases  which  have  previously  been 
ascribed  to  the  protein  excesses.^ 

Palatability  and  Idiosyncrasy 

The  question  of  palatability  must  be  considered.  Cooking,  con- 
diments in  reasonable  amounts,  flavoring  materials,  and  pleasant 
surroundings  add  not  only  to  palatability  but  also  to  the  digestibility 
and  the  nutritive  qualities  of  foods.  These  factors  must  all  be 
taken  into  consideration  in  connection  with  the  treatment  of  poorly 
nourished  individuals. 

In  connection  with  the  above  Professor  Atwater  says:  "Digest- 
ability  is  often  confused  with  another  very  different  thing,  namely, 
the  agreeing  or  disagreeing  of  food  with  the  person  who  eats  it. 
During  the  process  of  digestion  and  assimilation  the  food  as  we 
have  seen,  undergoes  many  chemical  changes,  some  of  them  in 
the  intestines,  some  in  the  liver,  muscles,  and  other  organs.     In 


^Lusk:     Science  of  Nutrition. 
^McKillop:      Food   Values. 


58  PRINCIPLES    OF    OSTEOPATHY 

these  changes  chemical  compounds  may  be  formed  which  are  in  one 
way  or  another  unpleasant  and  injurious,  especially  if  they  are 
not  broken  down  (as  normally  they  are)  before  they  have  oppor- 
tunity thus  to  act.  Some  of  the  compounds  produced  from  the 
foods  in  the  body  may  be  actually  poisonous." 

"Different  persons  are  differently  constituted  with  respect  to 
the  chemical  changes  which  their  food  undergoes  and  the  effect 
produced,  so  that  it  may  be  literally  true  that  'one  man's  meat 
is  another  man's  poison.'  Milk  is  for  most  people  a  very  whole- 
some, digestible  and  nutritious  food,  but  there  are  persons  who 
are  made  ill  by  drinking  it,  and  they  should  avoid  milk.  The  writer 
knows  a  boy  who  is  made  seriously  ill  by  eating  eggs.  A  small 
piece  of  sweet  cake  in  which  eggs  have  been  used  will  cause  him 
serious  trouble.  The  sickness  is  nature's  evidence  that  eggs  are 
for  him  an  unfit  article  of  food.  Some  persons  have  to  avoid  straw- 
berries. Indeed,  cases  in  which  the  most  wholesome  kinds  of  food 
are  hurtful  to  individual  persons  are,  unfortunately,  numerous. 
Every  one  must  learn  from  his  own  experience  what  food  agrees 
with  him  and  what  does  not." 

This  question  of  personal  idiosyncracy  concerning  foods  is  an 
interesting  one.  In  some  cases  it  seems  to  depend  upon  distaste, 
and  this,  in  turn,  upon  unpleasant  emotional  associations.  In  other 
eases  it  seems  to  be  due  to  improper  functions  of  the  digestive 
organs.  Such  cases  often  lose  the  idiosyncracy  after  receiving 
osteopathic  treatment  and  the  correction  of  lesions  affecting  the 
digestive  tract. 

Dietetic  Habits 

The  time  for  eating  or  the  frequency  does  not  exercise  as  great 
an  influence  upon  body  conditions  as  one  is  led  to  think  by 
numerous  so-called  health  journals.  True,  one  may  eat  so 
often  as  to  prevent  recuperation  between  the  periods  of  activity 
of  the  digestive  apparatus.  The  frequent  eating  of  small  amounts 
of  food  is  not  necessarily  bad  practice  and  may  be  an  adequate 
method  of  meeting  certain  abnormal  gastric  conditions.  Overload- 
ing under  any  circumstances  is  objectionable.  An  abrupt  change 
in  dietetic  habits  is  of  more  importance  as  a  cause  of  digestive 
troii])le  than  is  the  particular  habit  of  the  individual. 


BODY  FUEL  59 

Eating  in  Disease 

With  disease  conditions  present  the  viewpoint  is  somewhat 
changed.  Yet  we  are  largely  in  the  dark  with  reference  to  the 
dietetic  principles  to  be  employed  in  particular  cases.  In  most 
cases  appetite  is  a  safe  guide  in  health  and  within  limits  it  is  also 
in  disease.  Very  few  cases  present  themselves  where  it  is  advisable 
to  force  an  individual  to  eat  against  his  own  desire.  "Just  a  little 
to  keep  up  strength"  is  advice  and  practice  M^hich  is  accountable 
for  numerous  prolonged  disorders.  The  patient's  desire  will  usually 
indicate  the  time.  But  it  is  equally  faulty  logic  to  withold  nour- 
ishment long  after  the  appetite  has  returned.  Fasting  for  ten, 
twenty,  thirty  days  is  advocated  by  various  physicians,  many  of 
whom  rejoice  in  the  reputation  of  following  all  methods  of  treat- 
ment that  are  natural!  Excesses  are  always  unnatural,  and  the 
substitution  of  one  abnormal  condition  for  another  is  never  logical 
and  is  rarely  advantageous.  The  individual  may  get  well,  but  the 
result  is  only  another  of  the  indications  that  the  organism  may  reg- 
ulate its  function  even  under  adverse  circumstances.  Like  surgery, 
the  long  fast  is  sometimes  a  useful  method  of  treatment. 


CHAPTER  XI 

A  SELF-SUFFICIENT  MACHINE 

While  it  is  necessary  to  make  emphatic  the  fact  that  the  human 
body  is  machine-like  in  its  structure  and  operations  it  must  not  be 
forgotten  that  it  is  far  more  than  a  machine  in  the  usual  sense  of 
that  word.  It  surpasses  the  ordinary  machine  in  the  fact  that  it  is 
self-feeding,    self-oiling,   self-operating,    and   self-regulating. 

By  virtue  of  the  facts  emphasized  in  the  previous  sections  the 
body  organism  is  enabled  to  care  for  itself,  so  long  as  it  is  supplied 
with  normal  diet  and  environment,  for  its  natural  duration  of  life. 
The  importance  of  this  idea  is  such  that  it  will  be  considered  at 
some  length.  If  it  were  asked  what  fact  is  most  striking  and  most 
fundamental  in  the  osteopathic  philosophy,  we  should  unhesitat- 
ingly affirm,  the  self-regulating  power  inherent  in  protoplasm.  At 
the  outset  it  must  be  noted  that  the  organism's  power  of  self -pro- 
tection is  not  unlimited.  While  from  one  viewpoint  it  is  preferable 
to  consider  all  things  as  co-operating  for  the  ultimate  good  of  each 
other  rather  than  as  a  life-and-death  struggle  for  existence,  yet 
the  latter  condition  undoubtedly  does  represent  one  of  the  tenden- 
cies of  all  nature.  Hence  it  is  presumptuous,  in  view  of  known 
facts,  to  assume  that  the  body  organism  will  triumph  in  all  its 
encounters.  But  the  fact  that  it  is  sufficient  for  ordinary  condi- 
tions of  environment  and  for  numerous  and  extreme  emergency  con- 
ditions must  be  emphasized  by  a  few  illustrations. 

In  Health 

1.  It  is  self-sufficient  functionally  in  health.  Note  an  illus- 
tration in  the  mechanism  of  circulation:  the  stomach  on  the  inges- 
tion of  food  needs  an  increase  of  blood.  The  food  materials  act 
as  a  stimulus  to  certain  nerve  terminals  in  the  gastric  mucosa; 
afferent  impulses  are  sent  to  a  nerve  center  in  the  spinal  cord 
where  efferent  impulses  are  generated,  resulting  in  a  dilatation  of 
the  gastric  arterioles;  the  general  blood  pressure  remaining  unal- 
tered, an  increased  blood  flow  to  the  stomach  is  inevitable.  In  res- 
piration :  by  reason  of  an  increase  in  metabolism,  an  excess  of 
carbon  dioxid  is  generated  and  modifies  the  normal  condition   of 

60 


A  SELF-SUFFICIENT  MACHINE  61 

the  blood;  that  excess  acts  as  a  stimulant  to  certain  nerve  cells 
located  in  the  medulla;  these  generating  efferent  impulses  over 
the  nerves  controlling  the  respiratory  apparatus  cause  an  increased 
activity  of  that  mechanism  whereby  the  excess  of  carbon  dioxid 
is  eliminated.  In  heat  regulation  (thermotaxis)  :  the  individual 
is  exposed  to  a  sudden  lowered  external  temperature ;  by  nerve 
influence  and  direct  effect  superficial  vaso-constriction  and  deep 
vaso-dilation  occur,  the  individual  shivers,  draws  his  limbs  closer  to 
his  body;  hence  not  only  a  lessened  opportunity  for  heat  loss  but 
through  several  media  an  increased  metabolism  results,  which  means 
the  maintenance  of  the  average  body  temperature  within  narrow 
limits.  Protection  against  poisoning  from  toxic  materials  produced 
in  normal  metabolism,  is  strikingly  illustrated  in  the  case  of  the 
conversion  of  ammonia  which  is  quite  poisonous"  into  urea  which 
is  much  less  so,  by  the  cells  of  the  liver.  In  vomiting  is  seen  an 
example  of  an  emergency  function  exemplifying  self -regulation ; 
an  irritating  substance  is  taken  into  the  stomach  which,  acting  as 
an  intense  stimulus  on  terminals  of  the  vagus  nerve,  causes  afferent 
impulses  to  pass  to  the  vomiting  center  in  the  medulla;  efferent 
impulses  sent  out  over  the  vagus,  the  lower  intercostals,  and  the 
phrenic,  cause  a  forcible  expulsion  of  the  irritating  materials,  at 
the  same  time  through  other  mechanisms  the  orifices  of  the  stom- 
ach are  co-ordinated,  the  glottis  closed,  and  anti-peristalsis  of  the 
esophagus  occurs.  In  the  depressor  nerve  another  emergency  func- 
tion is  provided  for;  under  ordinary  conditions  of  blood  pressure 
that  nerve  is  inactive.  When  by  reason  of  increased  peripheral 
resistance  or  other  cause  the  pressure  becomes  excessive,  terminals 
of  the  nerve  in  the  walls  of  the  ventricle  are  stimulated,  efferent 
impulses  are  sent  to  the  vaso-motor  center  and  general  and  special 
dilation  occurs  with  a  consequent  lowering  of  pressure. 

In  Disease 

But  also  in  disease  conditions  we  note  the  regulation.  In  the 
high  temperature  of  the  body  we  have  a  condition  unfavorable  to 
the  development  of  micro-organisms  which  are  known  to  be  asso- 
ciated with  various  fever  states.  High  temperature  is  brought  about 
by  the  disturbed  condition  of  the  body,  the  excess  of  waste  producing 
a  condition  of  toxity,  which  acts  as  a  stimulus  to  an  excessive  meta- 
bolism resulting  in  an  overactive  oxidation.     In  great  part  the  rise 


62  PRINCIPLES  OF  OSTEOPATHY 

in  temperature  results  from  a  lessened  heat  loss  through  peripheral 
vaso-constrietion.  The  heat  thus  generated  acts  not  only  in  the 
manner  suggested  above  but  assists  in  ridding  the  body  of  foreign 
and  waste  material  by  burning  it.  The  spirilla  of  recurrent  fever 
lose  their  mobility  at  40°  C.  (104°  F.) ;  the  most  favorable  temper- 
ature for  the  tubercle  bacillus  is  37°-38°C.  (99.5  °F.)  the  propaga- 
tion of  the  streptococcus  erysipelatus  is  terminated  at  40°C.  (104^.) 
and  the  organism  is  killed  at  4rC.  (105.8°F.) 

Slosson  has  shown  that  leucocytes  move  with  increased  activity, 
and  engage  in  phagocytosis  more  efficiently,  when  the  cells  are 
kept  at  a  temperature  of  99°  to  lOS^F,  Their  efficiency  in  destroy- 
ing bacteria  and  in  removing  foreign  materials  is  thus  greatest  in 
mild  fevers.^ 

In  convulsions,  according  to  Dr.  Still,^  is  represented  an  effort 
to  overcome  a  disturbance  in  the  equilibrium  of  certain  of  the  vital 
forces.  The  increased  activity  of  the  skin  in  disturbed  renal  condi- 
tions represents  an  emergency  function  as  well  as  an  example  of 
the  substitution  power  of  the  body  organs.  In  infection  the  white 
blood  corpuscles  are  increased  in  number  and  efficiency  as  a  result 
oi  some  stimulus  dependent  on  the  presence  of  pathogenic  bacteria; 
while  in  addition  to  this  function  of  phagocytosis  of  the  white  blood 
cell  an  increased  antitoxic  condition  of  the  blood  and  tissues  is 
produced  dependent  on  the  same  factors."* 

Starvation 
In  starvation  the  body  is  preserved  in  a  remarkable  manner,  for 


^Jane  Slosson,  A.O.A.  Jour.,  July,  1917. 

^Still:     Philosophy  of  Osteopathy. 

^Stern  and  Korte  (Berl.  klin.  Wochen.,  1904,  No.  9,  p.  213),  by  using  a 
method  devised  by  Neisser  and  Wechsberg,  have  measured  the  bactericidal 
power  of  the  blood  serum  of  typhoid  fever  patients  and  of  normal  individuals. 
To  fixed  quantities  of  fresh  unheated  rabbit  serum  and  a  dilution  of  twenty- 
four-hour  bullion  culture  of  typhoid  bacilli  varying  amounts  of  heated  typhoid 
serum  were  added.  After  the  mixture  had  remained  at  36.5  C.  for  three  hours 
the  whole  was  plated.  The  authors  find  that  almost  complete  bacteriolysis 
takes  place,  even  when  typhoid  serum  is  used  in  very  high  dilutions.  In  a 
few  cases  the  serum,  when  diluted  50,000  times,  is  still  active.  Sera  from 
persons  who  have  no.t  had  typhoid  fever  possess  a  much  lower  bactericidal 
value,  and  usually  are  only  effective  in  dilutions  of  1:200  or  thereabouts.  No 
relationship  can  be  made  out,  either  between  the  severity  of  the  disease  or 
the  tendency  to  relapse  and  the  bactericidal  value  of  the  serum.  Neither  does 
there  appear  to  be  any  direct  connection  between  the  agglutinating  power 
of  the  serum  and  its  bactericidal  action.  Sera  diluted  beyond  the  agglutin- 
ating point  are  still  bactericidal. — American  .Tournal  of  The  Medical  Sciences, 
.rune.   1904. 


A   SELF-SUFFICIENT  MACHINE  63 

not  only  are  stored  foods — glycogen,  fat,  etc. — first  drawn  upon, 
but  when  the  source  of  supply  becomes  exhausted  the  organs  least 
essential  suffer  first.  The  following  table  from  Stewart's  Physi- 
ology, giving  percentages  of  total  organ  weight  lost  in  starvation 
is  suggestive : 

Brain    3  Kidneys    26 

Heart    • :....  3  Blood    27 

Bones    14  Muscles    31 

Pancreas    17  Testes    40 

Intestines  ..: 18  Liver 54 

Lungs    18  Spleen   67 

Skin    21  Fat    97 

During  fasting,  there  is  usually  a  tendency  to  assume  the  reclin- 
ing position,  to  avoid  exertion,  and  to  pass  many  hours  in  sleeping. 
There  is  usually  also  a  feeling  of  chilliness,  which  causes  the  patient 
to  seek  warm  places  and  to  wrap  himself  in  warm  clothing.  All  of 
these  factors  protect  the  body  from  loss  and  prolong  life. 

Structural  Relations 

2.  It  is  self-sufficient  structurally.  Note  the  calloused  condi- 
tion of  the  palms  in  the  ease  of  an  individual  who  performs  much 
manual  labor;  or  the  similar  hardening  of  the  gums  of  those  who 
are  without  teeth — structural  change  because  of  functional  increase. 
The  body  is  continually  meeting  with  mechanical  forces  sufficient 
to  temporarily  displace  parts,  e.  g.,  the  ribs,  in  which  the  normal 
tension  of  muscle  and  ligament  is  usually  sufficient  to  readjust. 
In  case  of  slight  wounds  blood  and  lymph  together  are  able  to  ap- 
proximate the  parts  and  secure  healing. 

But  also  in  disease  the  regulating  power  over  structure  is  man- 
ifested. When  the  structural  change  in  the  semi-lunar  valves  per- 
mits a  regurgitation  of  blood,  the  ventricular  muscle  hypertrophies 
to  correspond  to  the  increased  work  to  be  done;  in  which  ease  we 
have  a  compensatory  structural  change.  In  dislocation  of  the  hip 
where  tension  of  ligaments  and  muscular  effort  are  insufficient  to 
accomplish  reduction,  compensatory  changes  occur,  such  as  short- 
ening and  lengthening  of  muscles  and  formation  of  a  new  aceta- 
bulum with  adhesions  for  ligaments.  In  broken  bones  where  con- 
tinual motion  has  prevented  the  knitting  process,  "false  joints" 
have  been  formed  with  all  the  essential  structures,  articular  surfaces, 


64  PRINCIPLES  OF  OSTEOPATHY 

ligaments  and  synovial  membranes  imitated  or  formed.  In  local 
dilatation  of  the  upper  intestine  in  case  of  absence  of  the  stomach, 
and  in  dilatation  of  the  esophagus  after  obstruction  of  the  cardiac 
orifice  of  the  stomach,  and  in  the  compensatory  development  of  veins 
and  arteries  after  other  veins  and  arteries  have  been  destroyed,  we 
have  illuminating  instances  of  the  ability  of  the  organism  to  rise  to 
the  occasion. 

The  above  facts  have  been  emphasized  for  the  purpose  of 
impressing  the  fundamental  proposition  that  all  processes  of  heal- 
ing are  dependent  on  the  inherent  power  of  protoplasm;  that  that 
inherent  power  to  heal  will  be  exercised  so  long  as  structural  con- 
ditions are  normal,  and  that  in  the  majority  of  cases  where  the 
structural  conditions  are  abnormal,  adjustment  of  the  latter  is  not 
beyond  its  power;  that  the  duty  of  the  physician  is  only  to  keep 
external  things — things  external  to  function — favorable  to  the  ex- 
ercising of  that  power. 


CHAPTER  XII 

THE  TENDENCY  TO  THE  NORMAL 

The  considerations  in  the  last  chapter  lead  to  a  more  definite 
determination  as  to  the  nature  of  the  normal  condition  and  the 
reasons  for  such  a  tendency  to  maintain  or  restore  that  condition. 
If  the  question  were  asked  as  to  what  constitutes  a  normal  condi- 
tion few  there  are  who  would  not  be  able  to  give  a  fairly  satisfactory 
answer  in  general  terms.  But  though  the  general  conception  were 
held  by  each,  to  explain  the  specific  elements  necessary  in  a  normal 
condition  is  a  task  of  some  considerable  difficulty. 

What  is  Normal? 

If  we  answer  that  a  normal  body  is  one  in  which  the  different 
parts  are  working  in  harmony  we  have  a  satisfactory  general  en- 
swer.  But  if  we  attempt  to  give  the  several  elements  a  mathemat- 
ical value  and  then  insist  upon  measuring  every  individual  by  that 
standard  we  will  certainly  meet  with  insurmountable  difficulty.  If 
by  careful  estimates  we  determine  that  33  grams  of  urea  is  the  nor- 
mal amount  excreted  in  24  hours,  shall  we  call  that  individual  ab- 
normal who  excretes  only  28  grams?  If  we  determine  that  72  beats 
per  minute  shall  be  the  standard  for  heart  action,  shall  we  decide 
that  Napoleon  whose  heart  rate  was  40  and  that  others  whose  rate 
was  below  or  above  the  average  figures  were  not  normal?  In  rela- 
tion to  men  collectively,  then,  no  standard  of  normality  can  be 
given.  But  what  about  the  individual?  Can  we  establish  a  stand- 
ard for  each  individual?  The  difficulties  are  identical.  The  indi- 
vidual condition  is  continually  changing  in  quality  and  quantity 
of  functioning.  The  change  is  no  evidence  of  a  departure  from 
the  normal.  It  is  the  normal  that  varies  and  hence  an  absolute 
value  cannot  be  given  to  the  various  elements  constituting  a  normal. 

If  we  shall  make  symptoms  the  criterion  of  our  judgment  we 
shall  certainly  fail  in  numerous  cases.  Many  diseased  conditions 
are  present  for  long  periods  of  time  though  presenting  absolutely 
no  noticeable  symptoms,  subjective  or  objective.  Further,  certain 
changes  in  appearance  ordinarily  considered  symptomatic   of  dis- 

65 


66  PRINCIPLES  OF  OSTEOPATHY 

ease  are  not  so  in  reality;  for  instance  a  rapid  heart  beat  is  usually- 
apparent  following  the  climbing  of  a  steep  hill.  The  individual  is 
not  subjectively  distressed  and  the  objective  symptom  of  rapid  heart 
beat  is  present.  But  the  actual  condition  instead  of  being  abnormal 
is  normal  under  the  circumstances.  Is  pain  an  abnormal  condition? 
Not  necessarily  nor  usually.  Subjectively  it  is  a  psychic  condition 
and  as  such  is  in  one  sense  a  product  of  cerebral  activity.  In  so 
far  as  it  is  a  vrarning  it  is  a  normal  condition  though  it  is  evidence 
of  some  abnormal  condition.  This  is  equally  true  of  other  sub- 
jective symptoms.  We  cannot,  therefore,  rely  upon  symptoms  alone 
as  a  criterion  for  judgment  of  a  normal  condition.  The  best  that 
can  be  done  under  the  circumstances  is  the  determination  of  the 
physiological  condition  of  an  individual  by  comparison  with  the 
average  condition  of  the  average  individual  under  similar  circum- 
stances. We  must  judge  the  fact  or  the  degree  of  abnormality 
according  to  the  presence  or  absence  of  symptoms,  or  of  disturb- 
ances of  function,  structure,  comfort  or  mentality,  or  according  to 
the  findings  secured  by  various  physical,  chemical  or  functional 
examinations,  since  the  exact  line  of  demarcation  between  normal 
and  abnormal  is  a  non-determinable  quantity. 

Heredity 

While  it  is  true  the  details  constituting  a  normal  condition  are 
not  confined  within  known  and  unyielding  limits,  the  general  forces 
back  of  the  tendency  may  be  determined.  In  the  first  place  there 
are  two  fundamental  forces  associated  with  the  life  of  each  organ- 
ism, the  first  of  which  is  heredity.  By  the  term  is  meant  that  pecul- 
iarity derived  from  the  total  ancestry,  that  compels  a  likeness  to 
type.  What  is  inherited?  (a)  The  life  principle  itself  and  (b)  the 
structure  of  the  body.  It  is  to  be  noted  that  inheritance  does  not 
refer  simply  to  the  relation  between  immediate  parent  and  offspring 
but  between  the  whole  line  of  ancestors  and  the  individual.  An 
individual  may  present  the  special  peculiarities  of  his  grandsire 
rather  than  those  of  his  sire,  in  which  case  there  is  a  special  quality 
of  germ  plasm  handed  down  through  the  parents  but  not  becoming 
manifest  in  them,  to  reappear  in  developed  form  in  the  grandson. 
Such  a  reversion  to  ancestral  characters  is  technically  referred  to 
as  atavism  or  reversion. 

^lany  peculiarities  of  heredity  must  be  considered.     The  Men- 


THE  TENDENCY  TO  THE  NORMAL  67 

delean  laws  govern  certain  hereditary  factors,  and  these  may  de- 
termine the  prognosis  in  certain  diseases.  Hereditary  structural 
conditions  may  predispose  to  certain  types  of  disease,  or  may  give 
comparative  immunity  to  other  diseases.  The  heredity  of  struc- 
ture includes  structures  within  the  body  as  well  as  those  visible; 
includes  microscopic  structures  as  well  as  macroscopic  structures. 

Variation 

The  second  great  force  is  that  of  adaptation  which  has  reference 
to  the  peculiarity  that  permits  an  unlikeness  to  type — a  peculiarity 
which  is  dependent  on  the  environment  for  its  manifestation.  What 
varies?  The  special  features  and  functions.  No  two  individuals 
are  alike  in  their  structural  or  their  functional  characters;  and  this 
individual  variation,  in  so  far  as  it  is  not  a  likeness  to  some  ancestor, 
is  depvendent  on  conditions  of  environment,  i.  e.,  dependent  on  stim- 
uli acting  upon  the  organism  during  its  separate  existence. 

Both  of  the  two  great  forces  are  necessary;  the  one  in  order 
that  stability  shall  be  preserved  and  the  identity  of  the  species 
maintained;  the  other  in  order  that  the  individual  shall  not  be 
disintegrated  because  of  an  absolutely  unyielding  nature.  Each 
one  of  the  two  forces  tends  to  counteract  the  extreme  tendencies 
of  the  other  and  hence  the  happy  medium  is  maintained.  Heredity 
alone  would  make  an  absolute  condition  necessary  to  a  normal  one. 
No  adaptation  to  the  continually  arising  new  circumstances  could  be 
possible.  Because  of  the  adaptation  associated  with  the  living  ma- 
terial variation  is  possible.  Hence  the  boundaries  of  the  field  of 
normal  action  are  markedly  widened.  Kecognizing  the  two  forces 
it  is  possible  to  explain  in  a  general  way  individual  peculiarities, 
such  as  a  difference  in  heart  beat,  in  bowel  activity,  and  perspiration ; 
and  circumstantial  peculiarities,  such  as  increase  in  respiration  de- 
pendent on  altitude,  hypertrophy  of  the  heart  in  valvular  disorders, 
thickening  of  tissues  in  cases  of  continuous  wear. 

These  conditions  become  of  special  interest  and  fundamental 
importance  to  the  osteopath  especially  in  their  application  to  the 
determination  of  lesions.  In  a  later  chapter  there  is  indicated  in 
detail  the  points  necessary  to  consider  in  the  diagnosis  of  a  lesion 
but  in  this  connection  we  wish  to  emphasize  one  case.  The  ten- 
dency of  the  beginning  osteopath  is  to  assume  that  every  variation 
of  structure,  especially  in  the  position  of  the  spinous  process,  is  a 


68  PRINCIPLES  OF  OSTEOPATHY 

lesion.  The  foregoing  considerations  would  suggest  some  possible 
exceptions.  Experience  demonstrates  that  there  are  numerous  et 
ceptions.  The  spinous  process  may  be  deviated  because  of  an  over- 
devolopment  of  muscles  on  one  side — the  right  in  right-handed  indi- 
viduals, for  example — or  from  a  faulty  condition  of  nutrition  in 
foetal  life,  or  from  various  other  forces,  which  while  causing  an 
appreciable  variation  from  the  average  condition  does  not  cause 
or  predispose  to  disease,  and  hence  could  not  rightly  be  called  a 
lesion.  What  is  true  of  the  position  of  parts  is  true  of  the  several 
other  conditions  that  may  be  present.  In  all  considerations  of 
diagnosis  the  possibility  of  unusual  appearances  being  normal  must 
be  recognized. 

Adaptation 

A  normal  individual  is  one  sufficiently  like  the  species  to  main- 
tain its  identity  as  a  member  of  that  species  but  pliable  enough  to 
change  in  any  part  or  function  sufficiently  to  meet  the  average 
emergencies  of  environment,  without  interfering  in  any  way  with 
associated  functions.  If  the  incidental  forces  are  sufficiently  in- 
tense or  prolonged  to  produce  a  modification  beyond  the  limits  of 
adaptive  response  disease  will  result.  Otherwise,  while  function 
and  structure  may  be  temporarily  modified,  disease  beyond  the 
limits  of  self-cure  will  not  occur.  As  a  specific  illustration  mention 
may  be  made  of  the  effect  of  a  change  of  altitude.  On  passing  from 
a  lower  level  to  one  considerably  higher  a  new  condition  of  environ- 
ment is  represented  in  the  rarer  atmosphere.  If  there  were  not  the 
principle  of  adaptation,  the  organism  would  soon  succumb  for  lack 
of  oxygen,  but  possessed  of  that  principle  the  organism  responds 
by  a  quantitative  change  of  function.  Respiration  and  heart  action 
are  quickened,  new  red  blood  cells  are  rapidly  formed,  and  vital 
equilibrium  thereby  maintained.  This  change  of  function  is  not 
perverted  function,  for  it  is  normal — necessary — under  the  circum- 
stances. The  normal  has  varied  to  meet  varying  circumstances, 
and  thus  normal  functions  are  maintained.  Temporarily,  the  in- 
creased function  may  distress,  but  permanently  other  functions  are 
unimpaired.  But,  if  this  change  of  air  pressure  be  extreme,  so  that 
the  organism's  adaptive  capacity  is  overreached,  functions  are  per- 
verted and  disease  beyond  self-cure  will  result. 

This  tendency  to  the  normal  results  in  part  from  certain  well 
known  principles  which  may  be  enumerated. 


THE  TENDENCY  TO  THE  NORMAL  69 

1.  First  are  those  of  a  physical  nature.  Self-reduction  of  lux- 
ations depends  to  a  considerable  extent  upon  the  difference  in  me- 
chanical tension  on  opposing  parts  of  the  luxated  structure.  In 
the  ease  of  the  formation  of  a  new  acetabulum  the  mechanical  pres- 
sure operates  to  produce  the  cavity.  The  discharge  of  irritating 
particles  from  the  bronchi  is  effected  by  an  apparatus  which  utilizes 
air  pressure. 

2.  The  tendency  may  depend  upon  chemical  conditions.  The 
carbon  dioxid  acts  as  a  chemical  stimulus  to  the  nerve  cells  con- 
trolling respiration.  Immunity  to  certain  diseases  through  the  me- 
dium of  an  increased  antitoxic  condition  of  the  blood  is  secured  by 
chemical  means.  The  coagulation  of  the  blood,  thereby  preventing 
its  own  loss,  is  largely  a  chemical  process. 

3.  In  many  instances  the  nature  of  the  reaction  is  not  well 
understood,  as  in  chemotaxis,  phagocytosis  and  many  co-ordinating 
activities. 

It  is  not  to  be  presumed  however  that  these  various  separate 
principles  act  separately  in  bringing  about  the  adjustment.  It  is 
likely  that  in  no  case  is  this  true  but  that  many  factors  are  associ- 
ated and  co-ordinated  by  the  organism.  And  thus  continually  guard- 
ing and  restoring,  the  organism  is  enabled  to  pass  its  alloted  exist- 
ence in  a  world  rife  with  changes  of  environment  which  may  at 
any  time  be  sufficient  to  inaugurate  disease.  But  by  virtue  of  the 
tendency  exercised  both  in  ordinary  and  extraordinary  circumstan- 
ces it  may  usually  triumph,  and  hence  it  is  in  a  very  real  sense  that 
the  statement  is  true  that  ' '  disease  is  the  stimulus  of  its  own  cure. ' ' 


CHAPTER  Xra 

THE  ETIOLOGY  OF  DISEASE 

In  a  previous  chapter  it  was  suggested  that  health  represents 
a  condition  of  body  harmony  and  that  disease  is  body  discord.  For 
purposes  of  convenience  perverted  function  may  be  accepted  as  a 
definition  of  disease.  While  this  is  not  entirely  satisfactory  in  that 
most  diseases  are  associated  with  structural  changes  also,  yet  the 
appearances  so  strongly  emphasize  the  prime  importance  of  func- 
tional perversion  that  use  will  be  made  of  the  phrase.  Granting 
that  there  are  limits  to  the  self-regulating  power  of  the  organism 
and  that  disease  does  exist,  it  becomes  necessary  to  inquire  into  the 
cause  of  disease :  and  first  will  be  mentioned  the  most  important  of 
two  general  causes. 

Abnormal  Structural  Conditions 

Whatever  in  addition  he  may  be,  man  is  certainly  a  machine. 
It  is  further  obvious  that  the  function  of  a  machine,  its  action,  is 
absolutely  dependent  on  its  structural  integrity  and  that  just  as 
soon  as  any  part  of  the  machine  becomes  disturbed  in  relation  to 
other  parts  disorder  of  action  will  result.  Is  this  true  of  the  man- 
machine?  It  would  seem  a  simple  proposition  easily  answered. 
Yet  objection  is  offered.  Without  at  this  time  entering  into  a  dis- 
cussion of  the  relative  placing  of  structure  and  function,  a  few 
facts  may  be  indicated  tending  to  prove  indisputably  the  contention 
that  the  abnormal  structural  condition  is  a  frequent  cause  of  per- 
verted function. 

Gross  Lesions 
Medical  history  teems  with  records  of  cases  where  at  least  gross 
anatomical  disturbances  indicate  definite  and  far-reaching  physiolog- 
ical disorder.  A  few  such  will  be  specified.  A  dislocated  hip 
or  a  subluxation  of  the  sacro-iliac  articulation,  or  a  lumbo-sacral 
subluxation,  will  cause  sciatica.  How  does  it  do  so?  By  direct 
pressure,  not  necessarily  on  the  nerve,  perhaps,  but  upon  structures 
closely  enough  associated  with  it — its  blood  supply,  for  example — 
to  result  in  its  disorder.  Note  the  statement  of  Church:  "Com- 
pression of  the  nerve  in  sitting  or  by  vigorous  action  of  the  leg- 

70 


THE  ETIOLOGY  OF  DISEASE  71 

flexors  and  rarely  contusion  from  blows  below  the  sciatic  notch 
may  induce  it.'"  Strumpbell  refers  to  "neuralgias  secondary  to 
trauma  and  compression."-  A  dislocated  cervical  or  even  lumbar 
vertebra  will  cause  paralysis  by  pressure  upon  the  spinal  cord  or 
upon  its  sources  of  supply.  Seudder  refers  to  cervical  conditions 
in  this  manner:  "The  most  common  form  of  cervical  dislocation 
is  that  occurring  upon  one  side,  and  is  usually  without  fatal  result. 
This  is  rather  a  common  injury.  It  is  often  unrecognized."^  An 
occluded  blood  vessel  may  cause  gangrene.  Note  Nanerede's  state- 
ment :  ' '  Indeed  except  when  the  traumatism  physically  disintegrates 
tissues  as  a  stone  is  reduced  to  powder,  heat  or  strong  acids  phys- 
ically destroy  structure,  or  cold  suspends  cellular  nutrition  so  long 
that  when  this  nutrition  becomes  a  physical  impossibility  vital  metab- 
olism can  not  be  resumed,  gangrene  always  results  from  total  de- 
privation of  pabulum. '  "*  He  also  indicates  that  most  surgeons  assert 
that  the  moist  form  depends  in  part  upon  interference  with  drain- 
age. According  to  many  authors  and  investigators,  including  the 
renowned  Virchow,  the  gastric  ulcer  is  caused  by  a  disturbance 
of  the  circulation  by  embolism  or  other  occlusion  or  obstruction. 
A  flat  chest  vitiates  lung  tissue  and  renders  it  susceptible  to  invasion 
by  bacteria.  Pregnancy  by  pressure  on  renal  vessels  produces 
albuminuria.  Sclerosis,  overgrowth  and  hardening  of  connective 
tissue  structure,  causes  paraplegia  and  similar  conditions.  Tachy- 
cardia may  be  caused  by  pressure  paralysis  of  the  vagus  nerve 
from  "  tumors,  aneurism,  enlarged  lymph-glands,  *  *  *  *  in  the  neck 
or  the  thorax."'  A  sprained  ankle  causes  congestion  and  infiltration, 
thereby  producing  various  sensory  and  motor  disturbances  directly 
and  reflexly.  And  finally,  "the  movements  of  the  muscles  of  the 
neck,  by  pressing  on  the  jugular  vein,  are  sufficient  to  affect  the 
cerebral  circulation. '  '^ 

Lesions  of  Less  Degree 

In  all  the  cases  mentioned  above  we  have  illustrations  of  the 
fact  that  function  depends  on  structure.     That  such  cases  exist  is 


^Church   and  Peterson:     Nervous  and  Mental  Diseases. 
2StrunipbeIl:      Text-Book   of   Medicine. 

'Seudder:     The  Treatment  of  Fractures  with  Notes  upon  a  few  Common 
Displacements. 

^Nancrede:     Principles  of  Surgery. 
^Anilers:     Practice  of  Medicine. 
«Schafer:     Text-Book  of  Physiology. 


72  PRINCIPLES  OF  OSTEOPATHY 

recognized  by  all  authorities  and  is  disputed  by  none.  In  all  of 
these  cases  the  anatomical  perversion  is  a  gross  one  and  the  func- 
tional change  is  also  gross.  Why  should  we  limit  the  application  of 
the  principle  to  the  gross  cases?  Let  us  further  analyze  some  of 
the  above  instances.  All  are  agreed  that  the  dislocation  of  a  hip 
can  produce  an  inflammation  of  the  sciatic  nerve.  Is  it  a  greater 
tax  on  the  intellect  to  conceive  of  a  functional  disorder  of  less 
degree  dependent  upon  a  less  severe  structural  perversion? 

l^'  an  intense  stimulus  will  produce  neuritis  why  will  not  a 
less  intense  but  long  continued  stimulus  produce,  if  not  a  neuritis, 
at  least  an  appreciable  disorder  of  some  other  kind,  for  instance, 
a  deadening  effect,  a  numbness,  or  change  in  vasomotor  impulses  that 
are  carried  by  the  sciatic  nerve?  Note  the  case  of  the  p^aralysis, 
partial  or  complete,  dependent  on  dislocation  of  a  cervical  vertebra. 
Is  it  an  insult  to  intelligence  to  assent  to  the  proposition  that  if  a 
gross  dislocation  can  produce  a  paralysis,  a  less  perversion,  for 
instance,  a  severe  torsion  or  strain,  may  so  impinge  not  upon  the 
cord  directly  but  upon  the  innumerable  channels  that  connect  the 
contents  of  the  neural  canal  with  the  structures  anterior  to  the 
spinal  column,  as  to  very  materially  interfere  with  the  exchange 
between  these  regions? 

If  it  be  possible  that  gangrene  of  a  tissue  is  dependent  on  the 
total  obstruction  to  the  arterial  supply  to  that  tissue,  why  is  it  not 
reasonable  that  a  partial  interference  with  the  flow  of  blood  through 
an  artery  may  result  in  a  less  completely  starved  condition?  That 
partial  interference  may  easily  be  produced  by  direct  pressure  of 
structures  upon  it  or  by  interference  with  the  nerve  mechanism 
which  governs  its  diameter.  And  if  an  enlarged  lymphatic  gland 
may  by  pressure  produce  a  rapid  action  of  the  heart  through  inter- 
ference with  the  inhibitory  function  of  the  vagus,  why  is  it  not 
reasonable  that  tightened  conditions  in  the  spinal  structures,  by 
pressure  upon  the  accelerator  fibres  found  in  the  sympathetic,  may 
produce  a  similar  overactivity  of  the  heart?  There  is  no  question 
that  such  tightened  conditions  occur,  and  are  followed  by  such 
cnrdiac  disorders. 

If  the  lungs  are  weakened  by  a  depressed  condition  of  the  thorax 
v/alls,  why  is  it  not  true  that  the  heart  may  suffer  from  a  like 
crowding,  or,  through  a  weakened  diaphragm  which  reasonably 
could  follow  the  depressed  ribs,  a  general  ptosis  of  the  abdominal 


THE  ETIOLOGY  OF  DISEASE  73 

organs  result?  If  it  is  possible  that  contraction  of  cervical  muscles 
produces  a  change  in  cerebral  circulation  why  may  not  a  chronic- 
ally contracted  muscle  produce  a  chronic  disturbance  of  that  cir- 
culation and  hence  a  congested  headache? 

If  a  pregnant  uterus  by  virtue  of  its  size  and  weight  may  produce 
renal  disorder  by  pressure,  why  may  not  a  tumor  or  a  subluxated 
bone,  or  edematous  tissues  acting  upon  a  vital  structure  directly  or 
indirectly  connected  with  the  kidney,  produce  disorder  of  that 
organ  in  a  similar  manner? 

If  a  sprained  ankle  is  a  common  occurrence  and  if  congestion 
and  infiltration  are  resulting  conditions  which  cause  direct  and 
reflex  disturbances,  why  is  it  such  a  draft  upon  credulity  to  believe 
that  a  similar  common  condition  of  sprain,  with  similar  congestions 
and  infiltrations  and  similar  direct  and  reflex  disorders  may  occur 
in  the  scores  of  articulations  which  are  presented  by  the  spinal 
column  ? 

But  it  is  not  necessary  to  rest  the  case  entirely  on  assumption. 
Evidence  has  been  accumulated  and  is  still  accumulating  which  is 
most  confirmatory  in  character.  Case  after  case  has  been  found 
by  physicians  who  are  careful  in  observation  and  logical  in  judg- 
ment, showing  that  these  various  structural  perversions  are  present 
and  are  associated  with  functional  disorders,  the  removal  of  the 
structural  conditions  uniformly  resulting  in  a  disappearance  of  the 
disorder.  It  is  at  the  present  time  not  so  much  a  question  as  to 
the  fact  that  a  structural  disorder  produces  the  disease  as  to  the 
details  of  the  manner  in  which  the  latter  is  brought  about. 

(Experiments  performed  upon  animals,  especially  by  members 
of  the  staff  of  the  A.  T.  Still  Kesearch  Institute,  show  that  the  sub- 
luxations of  vertebrae  can  be  produced,  and  can  be  shown  in  stere- 
oscopic X-ray  plates;  that  these  lesions  do  produce  pathological 
changes  in  the  tissues  around  the  lesions,  and  that  distant  tissues, 
innervated  from  the  corresponding  segments,  also  suffer  patholog- 
ical changes. 

Other  experiments  show  that  the  correction  of  such  lesions  re- 
sults in  a  more  or  less  complete  recovery,  according  to  the  amount 
of  tissue  destruction  produced  before  the  correction  of  the  lesion. 
Full  accounts  of  these  experiments  are  published  in  the  bulletins 
of  The  A.  T.  Still  Research  Institute,  and  in  the  Journal  of  the 
American  Osteopathic  Association.) 


CHAPTER  XIV 

DISEASE  MAINTAINED  BY  STRUCTURE 

It  is  not  of  such  moment  as  to  what  was  the  original  stimulus 
to  a  disordered  function.  We  have  no  quarrel  with  those  who 
insist  that  the  functional  disorder  may  result  from  a  multitude  of 
forces  which  act  continually  upon  the  organism.  It  is  readily  admit- 
ted that  constant  disregard  for  well  known  laws  of  health  must  of 
necessity  produce  disorder,  and  in  another  section  special  attention 
is  called  to  the  fact.  The  more  important  question  is  to  determine 
what  is  fact  and  what  is  fiction  in  the  mass  of  rules  given  for  correct 
living.  A  thousand  conditions  of  environment  and  of  individual 
habit  may  initiate  or  predispose  to  disorder  of  function.  This  fact 
must  be  recognized  in  order  that  the  individual  shall  understand 
that  he  must  reap  what  he  sows.  It  must  be  a  part  of  the  work 
of  the  physician,  as  it  is  only  less  emphatically  the  duty  of  every 
man,  to  assist  in  a  proper  understanding  of  the  known  laws  of 
health,  and  a  proper  appreciation  of  the  responsibility  of  one's  own 
health,  bodily,  mental  and  spiritual.  Temperance  in  all  things  is 
absolutely  a  prerequisite  for  continued  well  being.  Any  intemper- 
ance will  result  in  at  least  a  temporary  impairment  of  function. 
With  most  normal  individuals  a  few  experiences  teach  wisdom. 
Hence  most  individuals  pass  through  life  with  a  fair  degree  of  health 
so  far  as  disorder  dependent  on  wilful  abuse  is  concerned.  When, 
however,  a  disorder  becomes  manifest  and  persists  in  spite  of  removal 
of  the  intemperance  or  abnormal  conditions  of  environment  it  is 
certainly  logical  to  assume  that  some  other  factor  is  maintaining 
the  disease.  The  osteopath  insists  that  the  other  factor  is  perver- 
sion of  structure,  and  that  structure  a  part  which  is  less  immediately 
and  less  completely  subject  to  vital  control — the  more  inert  tissues 
such  as  bone,  ligament,  cartilage,  and  other  connecting  structures. 
Hence,  where  a  disorder  is  maintained,  reason  and  observation  both 
indicate  that  the  structural  condition  is  the  factor  that  prevents  a 
return  to  normal  functioning.  The  question,  therefore,  is  not  as 
to  the  original  force  that  caused  the  disorder,  but  why  does  not  the 
sick  man  get  well? 

It  is  just  as  much  a  normal  power  of  the  organism  to  return 

74 


DISEASE   MAINTAINED  BY   STRUCTURE  75 

to  normal  functioning  as  it  is  to  maintain  functional  equilibrium 
manifest  in  the  ordinary  healthful  life.  It  is  in  fact  impossible  to 
differentiate  between  the  two.  An  excess  of  carbon  dioxid  is  a 
normal  stimulus  to  the  removal  of  that  excess.  The  organism  re- 
stores its  proper  function  largely  through  the  medium  of  stimuli 
furnished  by  its  own  katabolic  products.  The  presence  of  other 
substances  not  nutritive  in  character,  e.  g.,  bacterial  products,  pro- 
duces a  similar  result. 

Whether  through  ages  of  adaptation  and  from  hereditary  trans- 
mission or  from  inherent  endowment  co-equal  with  life  itself,  the 
fact  that  this  self -protective  power  exists  may  be  affirmed  with  little 
probability  of  error ;  and  that  function  is  self -regulative  while  struc- 
ture is  only  less  responsive  to  the  same  forces  is  equally  certain. 
Hence  in  the  ordinary  disorder  that  seems  beyond  the  limits  of  self- 
restoration  we  must  logically  look  to  the  structural  condition  for 
the  factor  maintaining  the  disorder.  Experience  has  shown  that 
little  in  addition  is  needed,  for  with  the  average  individual  the  aver- 
age environment  constitutes  a  normal  condition.  With  such  an 
environment  to  which  the  individual  has  long  been  accustomed  the 
organism  is  master  of  the  situation  and  needs  only  freedom  to  exer- 
cise its  restorative  powers. 

The  truth  of  these  considerations  is  evident  in  case  of  chronic 
disorder.  But  they  are  no  less  true  if  less  evident  in  acute  condi- 
tions. It  is  said  that  95  per  cent,  of  acute  cases  get  well  whether 
they  are  treated  or  not.  This  does  not  argue  for  a  policy  of  non- 
interference. For  osteopathic  experience  shows  unquestionably  that 
the  reparative  forces  may  be  given  greater  freedom  for  action  by 
appropriate  treatment.  In  general  the  length  of  time  required  by 
the  unaided  organism  to  restore  normal  conditions  may  be  lessened 
one-half.  What  is  the  philosophy  of  the  treatment  under  such  cir- 
cumstances? Under  the  influence  of  visceral  disease  reflex  mus- 
cular contractions  lead  to  disturbed  spinal  relations,  and  secondary 
lesions  are  produced.  This  structural  perversion  is  a  further  cause 
of  functional  perversion,  and  may  prevent  or  delay  recovery  from 
the  original  disease,  or  may  cause  other  and  more  chronic  diseased 
conditions,  perhaps  in  other  viscera. 

Hence  by  keeping  the  structural  condition  normal  the  total  time 
for  recovery  is  apparently  shortened.  If  this  assistance  is  not  given 
the  organism  recovers  in  most  cases  unaided.     But  in  others  the 


76  PRINCIPLES  OF  OSTEOPATHY 

disease  becomes  chronic  not  because  the  disease  itself  or  the  envi- 
ronment or  habit  of  the  patient  is  necessarily  an  insurmountable 
hindrance,  but  because  the  inert  structure  which  was  disturbed  has 
become  fixed  in  its  relations. 

It  is  not  always  necessary  to  assume  that  the  perverted  struc- 
ture arose  as  a  secondary  result.  It  is  enough  to  note  that  in  many 
cases  there  exists  a  deranged  structural  condition  which,  not  of 
itself  capable  of  producing  marked  disorder,  yet  causes  lessened 
resistance  to  extraordinary  stimuli,  and,  when  the  disease  results 
from  the  latter,  prevents  a  complete  response  to  the  new  conditions 
by  interfering  with  normal  nerve  or  blood  action.  In  such  cases 
the  structural  difficulty  is  part  of  the  original  cause  of  the  disease 
in  that  it  represents  a  predisposition.  It  becomes  the  principal  if 
not  the  entire  factor  which  prevents  a  ready  return  to  normal. 


CHAPTER  XV 

THE  LESION 

By  osteopathic  usage  the  word  lesion  has  acquired  special  sig- 
nificance. The  surgical  conception  of  lesion,  any  hurt  or  injury  to 
a  part,  and  the  pathological  concept,  any  local  or  circumscribed 
area  of  tissue  undergoing  abnormal  functional  changes,  must  be 
carefully  distinguished  from  the  osteopathic  concept  which  is  any 
structural  perversion  which  produces  or  maintains  functional  dis- 
order. Note  first  that  the  definition  includes  all  tissues.  While  it 
is  true  that  the  bony  lesion  occupies  first  place  by  virtue  of  history 
and  importance,  muscular  and  ligamentous  perversions  are  rivals 
of  the  former  for  pre-eminence.  A  viscus  may  act  as  a  lesion,  and 
among  the  most  serious  of  diseases  are  those  directly  dependent 
upon  pressure  from  prolapsed  viscera.  In  the  second  place  note 
that  the  structure  must  be  perverted,  that  is,  has  departed  from  the 
usual  or  average  condition.  Third,  note  that  the  condition  of  func- 
tion is  included  in  the  conception  of  lesion.  This  is  of  fundamental 
importance.  From  what  has  been  said  in  a  previous  section  it  can 
be  understood  that  a  structure  may  be  perverted  in  the  sense  of 
being  unusual  and  still  not  be  a  cause  for  change  of  function.  This 
variation  is  still  within  the  limits  of  normal  adaptation.  A  spine 
may  have  its  curves  markedly  exaggerated  or  completely  obliterated 
and  the  functional  conditions  still  remain  normal.  To  make  of  it 
a  lesion  in  the  osteopathic  sense  there  must  be  included  the  idea  of 
functional  disorder  as  a  consequence  of  the  structural  perversion. 

The  perverted  structural  condition  may  be  a  disturbed  positional 
relation  of  parts.  These  may  be  further  classified  into  (a)  disloca- 
tion, which  usually  refers  to  bony  tissue  and  represents  a  condition 
in  which  there  is  a  complete  separation  of  the  articular  surfaces. 
An  example  of  this  class  would  be  a  hip  dislocation,  (b)  Sublux- 
ation, also  usually  referring  to  bony  structures  but  in  which  there  is 
an  incomplete  separation  of  the  articular  surfaces,  is  a  second  type. 
A  rib  is  more  commonly  subluxated  than  dislocated,  (c)  Displace- 
ment is  more  commonly  applied  to  yielding  structures  and  especially 
viscera  in  which  there  are  no  well  marked  or  special  articulating 

77 


78  PRINCIPLES  OF  OSTEOPATHY 

surfaces.  It  is  more  appropriate  to  speak  of  a  displaced  uterus 
than  of  a  subluxated  or  dislocated  one.  (d)  The  lesion  may  be  in 
the  nature  of  contraction  or  contracture,  more  especially  of  muscu- 
lar tissue.  AVhile  it  is  true  that  all  living  tissue  is  more  or  less 
susceptible  to  change  in  shape  through  the  phenomenon  of  contrac- 
tion, muscle  tissue  because  of  its  specially  developed  power  in  this 
particular  must  occupy  first  place.  While  the  contraction  is  a  posi- 
tion change  it  is  also  a  size  change  and  might  appropriately  be 
considered  in  the  next  division.  For  there  is  undoubtedly  in  the 
majority  of  chronic  muscular  contractures  an  increase  in  the  total 
bulk  of  the  muscle  though  not  necessarily  in  the  amount  of  mus- 
cular fiber. 

(Studies  made  of  such  muscles  by  Dr.  C.  P.  McConnell  and  in 
the  laboratories  of  the  A.  T.  Still  Research  Institute  show  that  the 
first  changes  include  edema,  hemorrhage  per  diapedsin,  and  cloudy 
swelling.  There  is  diminished  alkalinity,  and  the  condition  of  the 
muscles  resembles  that  of  early  rigor  mortis.  After  some  months, 
an  increase  in  the  connective  tissue  elements  occurs,  many  of  the 
muscular  fibers  atrophy,  the  muscle  shortens,  and  the  condition 
properly  called  "contracture"  is  produced.) 

In  the  second  place  the  disorder  may  be  a  disturbed  size  relation 
of  parts.  These  may  be  also  further  classified  into  (a)  lesions  from 
overgrowth.  In  the  case  of  a  hypertrophied  heart  or  a  thoracic 
aneurism  direct  pressure  is  exerted  upon  the  lungs  and  other  tho- 
racic rtructures  with  resulting  disorder  of  the  function,  (b)  Arrest- 
ed grovth  and  (e)  atrophy  are  less  common  conditions  but  are 
occasionally  noted.  In  the  case  of  an  atrophied  liver  the  resulting 
disturbance  of  associated  abdominal  viscera  may  be  directly  depend- 
ent upon  the  size  disturbance,  (d)  Perverted  growths,  as  in  the 
case  of  exostoses  and  tumors  which  are  special  forms  of  overgrowth 
conditions,  are  considered  as  lesions. 

The  Causes  of  Lesions 

For  purposes  of  convenience  the  causes  of  lesions  may  be  class- 
ified into  external  or  environmental,  and  internal.  Among  the  for- 
mer the  most  common  is  mechanical  violence  such  as  a  blow,  a  fall, 
a  mechanical  shock  or  jar  to  the  organism  produced  in  whatever 
way.    It  will  be  found  on  inquiring  into  the  history  of  a  vast  number 


THE  LESION  79 

of  cases  of  disease  that  the  onset  of  the  disorder  was  noticed  soon 
after  having  suffered  the  violence,  and  owing  to  this  fact  it  is  always 
the  part  of  wisdom  to  inquire  carefully  into  the  history  of  the  case. 

Mechanical 

These  mechanical  causes  act  alike  in  producing  bony,  muscular, 
ligamentous  or  visceral  lesions.  A  prolapsed  uterus  is  often  found 
to  have  its  cause  in  a  sudden  mechanical  jarring  of  the  body.  A 
subluxated  rib  is  a  common  result  of  direct  pressure  from  without 
such  as  might  occur  in  the  strenuous  periods  of  a  football  game 
or  the  less  intense  but  more  prolonged  compression  of  certain  steel 
braces  constituting  a  part  of  the  wardrobe  of  fashionable  woman. 
A  sudden  attempt  to  protect  one's  self  from  falling  accounts  for 
a  strained  muscle,  a  sprained  articulation,  or  a  subluxated  vertebra. 


Thermal 

Another  important  external  cause  is  that  of  temperature  change. 
In  order  that  a  thermal  condition  shall  produce  its  effect  on  respon- 
sive tissue  it  must  be  a  sudden  change  and  usually  a  change  from 
a  higher  to  a  lower  temperature.  While  experimental  physiology 
indicates  the  possibility  of  a  contracted  muscle  dependent  on  a 
change  from  a  lower  to  a  higher  temperature,  little  evidence  has 
been  produced  to  show  that  a  similar  condition  is  produced  in  the 
normal  living  human  body  under  those  circumstances.  Lack  of 
evidence  however  does  not  prove  that  the  contraction  may  not  be 
brought  about  in  the  way  suggested.  With  regard  to  the  production 
of  contracted  muscles  resulting  from  sudden  exposure  to  cold  atmos- 
phere or  a  cold  draught,  all  osteopaths  are  agreed  in  emphatic 
affirmation.  The  primary  effect  in  point  of  time  and  importance, 
then,  will  be  the  production  of  a  muscular  lesion.  But  remember- 
ing the  intimate  relation  existing  between  muscles  and  other  tissues 
it  is  easily  understood  how  a  bony  or  ligamentous  lesion  may  come 
about  as  a  consequence  of  a  muscular  contracture  or  chronic  con- 
traction. A  muscle  cannot  contract  without  an  approximation  of 
the  structures  to  which  the  muscle  is  attached.  Hence  if  it  be  a 
spinal  muscle  a  vertebral  lesion  will  be  produced,  or  if  it  attaches 
to  a  rib  that  structure  will  be  depressed  or  otherwise  disturbed. 


80  PRINCIPLES  OF  OSTEOPATHY 

Internal  Causes 

Of  the  internal  causes  of  lesions  posture  of  the  body  may  be 
mentioned  though  perhaps  with  equal  propriety  it  might  be  classed 
under  external  causes.  Especially  is  this  operative  in  the  case  of 
children  and  young  people,  the  most  common  form  of  lesion  which 
results  being  a  curvature  of  the  spine.  Any  cramped  or  distorted 
position  assumed  for  long  periods  at  a  time  will  with  a  fair  degree 
of  certainty  result  in  a  gradual  change  of  parts.  The  continual 
bending  over  the  desk  at  school  is  undoubtedly  accountable  for 
numerous  spinal  disorders.  Professions  and  trades  which  require  the 
assumption  of  peculiar  positions  furnish  their  quota  of  patients  with 
characteristic  lesions.  The  dorsal  inclination  of  the  head  in  the 
process  of  lathing  a  ceiling,  the  flexed  position  in  shoveling,  and 
the  stooping  of  the  compositor  at  his  case  are  all  illustrations  of 
the  point.  In  all  of  these  there  is  a  uniform  force  continuously 
acting  in  a  definite  direction,  the  inevitable  result  being  in  the  case 
of  yielding  human  tissue,  definite  changes  in  structure. 

Nutritional  disturbances  are  internal  causes  which  comprehend 
a  variety  of  specific  conditions  such  as  congestions,  and  anjemic 
states,  and  nerve  irritations.  These  in  most  cases  are  further  de- 
pendent upon  an  adjacent  structure  and  it  becomes  necessary  to 
seek  for  the  cause  of  the  congestion.  An  overworked  organ  through 
a  resulting  hypertrophy  of  its  tissue  becomes  a  lesion.  Not  only 
do  viscera  act  as  lesions  from  congestive  conditions  but  a  muscle 
may  become  contracted  through  impulses  transmitted  by  reflex 
pathways  from  the  viscus.  In  practically  every  acute  case  with 
which  the  osteopath  comes  in  contact  there  are  found  muscle  con- 
tractions, in  part  primary  to  the  disease,  in  part  secondary  to  it. 
by  the  known  anatomical  facts  of  central  association  between  spinal 
nerves  and  visceral  nerves,  and  the  known  physiological  fact  of 
the  radiation  of  impulses  from  one  part  of  the  spinal  cord  to  another, 
a  reasonable  explanation  is  not  difficult.  Afferent  impulses  aroused 
by  a  disturbed  viscus  are  transmitted  to  the  spinal  cord  from  which 
efferent  impulses,  motor  or  vasomotor,  pass  to  the  spinal  muscles. 
That  such  an  explanation  is  reasonable  is  further  suggested  by  ref- 
erence to  Head's  law  relating  to  sensory  nerves.  This  law  suggests 
an  intimate  relation  between  afferent  nerves  closely  connected  cen- 
trall^y ;  and  the  histology  of  the  spinal  cord  shows  a  close  structural 
relationship  between  sensory  and  motor  centers,  while  experiments 


THE  LESION  •        81 

and  clinical  evidence  prove  from  a  functional  standpoint  equally 
close  central  connection  between  an  afferent  visceral  nerve  and  an 
efferent  motor  nerve.  Congestion  or  other  nutritional  disturbances 
in  the  muscle  tissue  do  undoubtedly  lead  to  contraction  of  muscles. 
(Animal  experiments  prove  that  irritation  of  viscera,  such  as  may 
be  due  to  visceral  disease,  cause  reflex  contractions  of  the  spinal 
muscles,  often  such  as  to  cause  recognizable  spinal  lesions.  See  the 
Bulletins  of  the  A.  T.  Still  Research  Institute.)  Experimental  in- 
vestigation in  the  laboratory  shows  that  weak  acids  may  be  efficient 
stimuli  for  the  contraction,  and  it  is  noted  that  just  such  a  condition 
is  present  in  venous  congestion  or  in  the  fatigued  muscles.  Venous 
blood,  always  less  alkaline  than  arterial,  becomes  appreciably  acid 
under  various  circumstances  of  the  organism,  due  to  the  presence 
of  carbonic  or  sarcolactic  acid,  the  latter  a  common  product  of 
katabolism.  In  fatigue  of  muscle  from  overwork  or  other  cause 
we  have  conditions  entirely  favorable  for  the  production  of  the 
special  form  of  contraction  which  is  well  known  to  the  osteopath. 
Here  the  excess  of  katabolic  waste  including  the  sarcolactic  acid 
referred  to  may  easily  be  sufficient  to  produce  the  effect.  On  the 
other  hand  anajmic  conditions  may  easily  be  responsible  for  abnor- 
mal states  of  the  muscle  and  the  cause  of  the  lesion,  though  this  is 
perhaps  a  more  debatable  proposition. 


CHAPTER  XVI 

MAINTENANCE  OF  THE  LESION 

Emphasis  has  been  given  to  the  fact  that  structural  perversion 
is  responsible  for  disordered  function ;  that  both  external  and  inter- 
nal forces  may  produce  the  structural  change;  and  that  the  organ- 
ism itself  is  usually  able  to  effect  readjustment  after  the  immediate 
causal  factor  ceases  to  operate.  Why  is  the  organism  not  successful 
in  all  cases?    Why  does  the  lesion  persist? 

If  the  physician  is  careful  in  his  observation  he  will  find  that  in 
a  large  number  of  cases,  especially  of  an  acute  nature,  there  are 
numerous  secondary  lesions  present  more  or  less  continuously 
throughout  the  course  of  the  disease ;  he  will  further  notice  that 
in  many  of  these  cases  both  perverted  function  and  secondary  lesion 
disappear  whether  treatment  be  given  or  not.  What  causes  or  forces 
or  conditions  are  present  in  those  who  become  normal  that  are  lack- 
ing in  the  numerous  cases  where  the  perversion  is  not  thus  self- 
corrected?  This  question  cannot  yet  be  answered  unequivocally, 
but  as  further  observation  is  made  and  deeper  study  given  several 
suggestions  offer  themselves  which  serve  to  explain  the  difficulty. 

In  the  case  of  a  dislocation  in  the  surgical  meaning  of  that  term 
there  is  little  about  which  an  issue  might  be  raised.  For  instance,  in 
a  dorsum  dislocation  of  the  hip  the  head  of  the  femur  lies  entirely 
outside  the  acetabulum,  from  which  it  is  separated  by  a  marked 
ridge  of  unyielding  tissue  which  is  an  effective  barrier  to  adjust- 
ment. In  a  complete  dislocation  of  the  cervical  vertebra  there  is 
present  a  condition  thus  described  by  Scudder:  "In  this  unilateral 
dislocation  of  the  cervical  vertebra  an  articular  process  slips  over 
the  articular  process  below  it  and  either  catches  upon  the  top  of 
the  lower  articular  process  or  slips  down  in  front  of  it."^  Here 
there  is  manifestly  sufficient  change  in  the  mechanical  relations 
of  the  processes  to  prevent  self-adjustment,  irrespective  of  any 
muscle  tension  that  may  be  associated.  But  the  case  may  be  quite 
different  in  the  ordinary  spinal  lesion  where  the  condition  is  not 


^Scudder:      The   Treatment   of   Fractures   with   Notes   Upon    a   few    Com- 
mon Displacements. 

82 


MAINTENANCE  OF  THE  LESION  83 

a  dislocation  but  a  subluxation,  and  in  many  cases  almost  inappre- 
ciable to  touch.  It  is  in  such  lesions  as  these  that  the  question  arises 
as  to  what  factor  or  factors  prevent  a  return  to  normal. 

In  presenting  the  suggested  explanations  it  is  necessary  to 
divide  the  cases  into  two  classes,  these  lesions  due  to  the  thermal 
or  other  change  which  initiate  muscular  contraction  as  the  primary 
perversion,  and  those  caused  by  sudden  violence  which  immediately 
produce  definite  strain  and  displacement  of  practically  all  the  parts 
comprising  the  articulation.  In  the  former  class,  so  far  as  the  simple 
uncomplicated  contraction  is  concerned,  that  should  disappear  just 
as  soon  as  the  stimulus  (cold  for  example)  is  removed,  and  hence 
the  case  will  hardly  require  attention.  But  experience  and  abstract 
theory  both  indicate  that  in  numerous  cases  the  muscular  lesion  is 
not  a  simple  one.  As  a  result  of  the  shortening  of  the  muscle,  deeper 
structures  are  disarranged  which  are  an  added  factor  to  consider 
in  investigating  the  lesion.  For  instance,  the  contraction  of  the 
serratus  posticus  inferior  produces  a  depression  of  the  lower  four 
ribs.  This  in  turn  disturbs  the  articular  structures  in  connection 
with  the  transverse  processes  and  bodies  of  the  vertebras.  These 
include  the  entire  connective  tissue  structures,  not  merely  the  syno- 
vial membranes  and  the  specialized  ligamentous  tissue.  In  this  case 
if  the  original  stimulus  to  contraction  is  immediately  removed,  the 
muscle  relaxes  and  no  harm  results.  But  if  that  original  stimulus 
be  not  removed,  or,  what  is  more  likely,  the  disturbance  of  the 
deeper  structures  causes  impairment  of  the  muscle's  blood  and 
nerve  control,  the  contraction  persists  so  long  as  the  deeper  struc- 
tural disorder  persists.  But  note  that  this  deeper  condition  is  not 
likely  to  remain  merely  as  a  tensed  or  strained  articulation.  Tension 
and  strain  produce  irritation,  irritation  results  in  congestion,  con- 
gestion is  associated  with  edema  and  a  large  number  of  abnormal 
local  conditions,  "When  the  case  has  reached  this  stage  essentially 
the  same  factors  are  presented  as  are  considered  in  the  second  class 
of  cases  referred  to  above,  these  lesions  due  to  a  definite  and  abrupt 
traumatism,  as  in  the  case  of  a  fall,  blow,  or  strain.  Hence  the 
further  course  of  the  two  classes  are  identical. 

What  occurs  when  a  joint  is  sprained?  DaCos'ta  thus  describes 
the  morbid  state:  "In  a  bad  sprain  ligaments  are  torn;  the  synovial 
membrane  is  contused  or  crushed;  cartilages  are  loosened  or  sep- 
arated; hemorrhage  takes  place  into  and  about  the  joint;  muscles 


84  PRINCIPLES  OF  OSTEOPATHY 

and  tendons  are  stretched,  displaced  or  lacerated ;  vessels  and  nerves 
are  damaged;  the  skin  is  often  contused;  and  portions  of  the  bone 
or  cartilage  may  be  detached  from  their  proper  habitat,  though 
still  adhering  to  a  ligament  or  tendon."^  Note  that  following  the 
accident,  unless  motion  be  produced  at  rather  frequent  intervals 
a  stiff  joint  is  the  result.  What  is  the  occasion  for  this  rigidity? 
Adhesions  and  thickenings  of  the  joint  structures  are  undoubtedly 
responsible.  Adhesions  usually  begin  while  the  inflammatory  state 
is  still  active,  which  is  also  true  of  overgrowth  conditions.  Hence 
this  complication  of  the  original  displacement  is  present  almost 
from  the  beginning.  There  can  be  little  question  that  such  a  state 
of  affairs  exists  in  numberless  spinal  lesions.  For  in  connection 
with  the  spine  are  scores  of  articulations,  each  of  which  is  continu- 
ally subject  to  the  identical  twists  and  wrenches  that  produce  the 
striking  effects  in  case  of  the  sprained  ankle.  The  less  noticeable 
character  of  these  sprains  is  sufficiently  explained  by  the  compara- 
tively small  size  of  any  individual  articulation.  In  the  case  of  a 
sprained  spine,  a  lesion  due  to  sudden  force,  the  factor  that  prevents 
correct  readjustment  is  certainly  not  simple  muscle  contraction ; 
it  is  principally  due  to  definite  change  in  position,  size  and  smooth- 
ness of  the  more  intimate  articulating  structures,  these  changes  in 
turn  dependent  upon  congestive  and  edematous  processes  resulting 
from  the  initial  strain. 

Is  it  true  of  the  condition  inaugurated  by  simple  muscular  con- 
traction? If  the  latter  produces  suflBcient  tension  of  the  deep  tis- 
sues, there  is  no  question  that  it  is  true,  though  perhaps  not  so 
marked  in  degree.  If  the  muscle  contraction  is  sufficient  to  ser- 
iously disturb  the  relative  position  of  the  articular  structures,  it 
is  also  sufficient  to  set  up  the  series  of  changes  suggested  above. 
If  the  condition  were  due  only  to  the  difference  in  muscular  ten- 
sion then  we  are  justified  in  the  massage  of  muscles  so  often  em- 
ployed by  not  a  few  practitioners.  As  a  matter  of  fact  the  masseur 
occasionally  produces  favorable  results.  He  does  it  in  those  com- 
paratively few  cases  where  muscle  contraction  is  the  sole  factor, 
or  where  his  work  is  sufficiently  deep  to  effect  a  real  adjustment. 

Essentially  then,  the  proposition  reduces  to  one  to  which  refer- 
ence must  continually  be  made,  namely  that  muscle  tissue  is  self- 
adjustive,  and  so  soon  as  the  stimulus  to  contraction  is  removed 


^DaCosta:     Modern  Surgery. 


MAINTENANCE  OF  THE  LESION  85 

there  is  little  if  any  necessity  for  direct  relaxing  measures.  The 
deeper  tissues — bone,  cartilage  and  other  connective  tissues  which 
are  less  capable  of  self-adjustment — are  the  structures  which  by 
virtue  of  their  size,  irregularities,  and  roughened  surfaces,  immedi- 
ately prevent  a  return  to  the  normal.  They  may  impair  the  vascu- 
lar or  nervous  state  of  other  tissues,  including  muscle,  and  these 
may  be  irregularly  tensed  and  thus  help  in  maintaining  the  lesion. 
In  conclusion  it  will  be  noted  that  in  all  likelihood  no  single 
factor  maintains  the  lesion.  Just  as  practically  every  spinal  lesion 
involves  bone,  ligament,  and  muscle,  so  the  persistent  nature  of  the 
lesion  is  due  to  more  than  one  factor. 


CHAPTER  XVII 

MEDIA  THROUGH  WHICH  LESIONS  PRODUCE  DISEASE 

1.  Direct  pressure  may  cause  the  organ  to  be  involved  in  dis- 
ease. A  rib  or  ribs  may  be  depressed  thereby  pressing  directly 
upon  the  lungs,  or  preventing  their  normal  expansion,  resulting  in 
immediate  disorder  or  a  lessened  resistance  to  specific  infection. 
A  floating  kidney  may  press  directly  upon  the  bowels  thereby  induc- 
ing constipation  or  other  trouble.  The  pyriformis  muscle  or  others 
closely  associated  may  in  contraction  impinge  directly  upon  the  sci- 
atic nerve  causing  a  neuritis. 

2.  Pressure  upon  the  artery  which  supplies  it  causes  an  anaemic 
condition  of  the  organ  and  a  possible  secondary  hypersemia  of  some 
closely  associated  part.  By  virtue  of  a  torsion  of  the  cervical  ver- 
tebra with  a  consequent  tightening  and  thickening  of  the  interverte- 
bral ligaments,  the  blood  flow  through  the  intervertebral  artery  is 
hindered  and  the  spinal  cord  suffers.  An  approximated  condition 
of  the  upper  ribs  impairs  the  arterial  supply  to  the  mammary  gland 
and  the  secretion  of  milk  is  hindered.  An  abdominal  tumor  or  a 
pregnant  uterus  impinges  on  the  renal  arteries  and  kidney  trouble 
is  experienced. 

3.  Pressure  upon  the  vein  which  drains  it  causes  a  hyperaemia 
of  the  organ  with  a  possible  secondary  anaemia  of  closely  associated 
structures.  A  depressed  sternum  and  anterior  ends  of  clavicle  and 
first  rib  through  pressure  upon  the  inferior  thyroid  is  one  cause 
ol  goitre.  A  tightened  muscular  and  ligamentous  condition  about 
the  saphenous  opening  may  cause  varicose  veins.  Muscular  contrac- 
tion in  the  cervical  region  interferes  with  the  drainage  of  the  cephalic 
structures  and  headache  results.  In  cirrhosis  of  the  liver  an  ob- 
struction to  the  portal  system  occurs  with  a  resulting  abdominal 
dropsy  and  a  secondary  anaemia  of  other  parts  of  the  body. 

4.  Xhe  organ  may  be  disordered  by  pressure  upon  the  lymph 
channels  with  which  it  is  associated,  thereby  producing  innumerable 
disordered  conditions  through  the  interference  with  nutritive  and 
sewerage  functions,  and  by  a  secondary  process  materially  affecting 
the  general  vascular  system. 

86 


MEDIA  THROUGH  WHICH   LESIONS  PRODUCE  DISEASE  87 

5.  Pressure  upon  a  nerve  directly  or  reflexly  connected  with 
it  causes  disorder  of  the  organ.  The  heart  may  be  interfered  with 
oy  tightened  ligaments  or  edementous  areas  causing  pressure  upon 
the  cardiac  accelerators  which  issue  from  the  spinal  cord  from  the 
first  to  the  fourth  thoracic  segments.  It  may  be  involved  in  disorder 
by  a  disturbed  uterine  condition,  in  which  case  it  is  a  reflex  effect. 
Or  the  accelerators  may  carry  too  many  or  too  rapid  impulses  to 
the  heart  dependent  on  contracted  spinal  muscles  in  the  upper  tho- 
racic area,  this  being  also  a  case  of  disturbance  dependent  upon 
reflex  action.  Note  the  physiological  law  that  the  total  activity  of 
a  segment  of  the  spinal  cord  varies  directly  with  the  algebraic  sum 
of  impulses  passing  to  it.  Note  the  extreme  number  and  variety  of 
effects  possible  from  nerve  disturbance.  A  sensory  impingement 
usually  produces  pain,  direct  or  referred  to  other  fields.  Every 
sensory  nerve  is  a  possible  pathway  for  impulses  setting  in  motion 
a  vasomotor  change;  hence  anaemic  or  hyperaemic  conditions  may 
result.  These  impulses  may  also  initiate  excessive  activity  of  the 
sweat  glands  and  hence  perspiration  becomes  abnormal.  The  nerve 
may  carry  the  impulse  which  inaugurates  the  change  in  any  efferent 
channel  and  hence  motion  may  be  increased  or  decreased,  secretion 
accelerated  or  depressed,  inhibition  modified,  trophicity  lessened. 
All  of  these  effects  are  dependent  on  interference  with  afferent  or 
sensory  nerves.  On  the  other  hand  the  efferent  channels  themselves 
are  equally  subject  to  interruption,  while  any  change  in  the  nutri- 
tive condition  of  a  segment  of  the  spinal  cord  or  a  center  in  the 
brain  affects  to  a  greater  or  less  degree  all  nerve  pathways  in  direct 
or  reflex  connection  with  them.  The  medium  of  nerve  interference 
is  without  doubt  the  most  important  with  which  we  deal. 

Through  these  several  media  we  may  explain  with  greater  or 
less  satisfaction  the  varied  results  that  have  been  observed  to  follow 
a  lesion.  The  difficulty  lies  in  determining  in  each  individual  case 
which  of  the  several  explanations  is  the  true  one — a  difficulty  at 
once  apparent  and  in  many  cases  insurmountable.  It  must  be  noted 
that  a  lesion  sufficient  to  produce  impingement  on  one  of  the  chan- 
nels is  sufficient  to  affect  another,  so  that  in  most  cases  we  will  have 
more  than  one  of  the  channels  interrupted  and  hence  the  greater 
possibility  of  extreme  effects. 


CHAPTER  XVIII 

VARYING  EFFECTS  OF  LESIONS 

The  extent  of  the  lesion  bears  no  constant  relation  to  the  inten- 
sity or  extent  of  the  effect.  Note  the  case  of  the  hunch-back  whose 
lesion  condition  is  quite  apparent  and  great  in  extent.  Yet  in  many 
cases  his  health  is  not  markedly  impaired.  On  the  other  hand  a 
slight  strain  at  the  articulation  between  the  eleventh  and  twelfth 
thoracic  vertebrae  has  resulted  in  immediate  nephritis  of  a  very 
serious  nature.  The  strain  was  barely  noticeable  on  palpation  or  in- 
spection, yet  the  effect  was  far  reaching.  Several  facts  suggest  an 
explanation  of  the  condition.  The  effect  varies  directly  with  the 
functional  activity  of  the  tissue  interfered  with.  If  a  lesion  brings 
pressure  upon  simple  connective  tissue  little  result  may  be  looked 
for.  The  connective  tissue  is  comparatively  inert.  If  the  pressure  be 
upon  nerve  tissue  the  result  is  far-reaching.  Nerve  tissue  is  most 
active.  It  is  developed  with  the  special  end  in  view  of  furnishing  a 
material  quick  to  respond  to  stimuli  and  capable  of  conducting  the 
impulse  to  other  parts  of  the  body.  Hence  a  lesser  intensity  of  stim- 
ulus from  pressure  will  be  necessary  to  cause  response  than  in  con- 
nective tissue  and  a  much  more  rapid  transmission  of  the  impulse  will 
also  result.  A  muscle  impinged  upon,  less  active  than  nerve  in  re- 
spect to  readiness  of  response  and  speed  of  propagation,  is  associ- 
ated with  less  immediate  effect.  An  artery  involved  is  more  likely  to 
result  in  disorder  than  is  some  other  structure  because  of  a  wider  in- 
fluence and  a  more  ready  response  to  pressure. 

Adaptation 

Again  the  adjustment  possibilities  of  the  structure  involved  in 
lesion  are  important  factors  in  modifying  the  response,  and  this 
is  in  turn  largely  dependent  on  the  abruptness  and  strength  of  the 
stimulus,  i.  e.,  the  pressure  from  the  lesion.  A  lesion  produced 
gradually,  as  is  true  in  most  cases  of  curvature  of  the  spine,  does 
not  constitute  a  change  sufficient  to  be  effective  as  a  stimulus.  Note 
that  it  is  an  abrupt  change  of  pressures  that  constitutes  a  mechan- 
ical stimulus.  In  the  case,  then,  of  the  posterior  curvature — the 
extreme  kyphosis — the  pressure  has  been  so  gradually  applied  that 

88 


VARYING   EFFiiCTS   OF   LESIONS  89 

the  structures  in  contact  were  not  stimulated  but  were  able  to  adapt 
themselves  to  the  gradually  changing  conditions.  It  is  a  recognized 
rule  in  physiology  that  a  change  sufficient  to  produce  a  response  in 
a  tissue  if  continuously  applied  will  later  fail  to  produce  such  re- 
sponse. The  tissue  has  adapted  itself  to  the  stimulus  and  is  not 
further  affected  thereby.  In  the  case  of  the  sudden  wrench  of  an 
articulation  causing  nephritis  the  change  in  pressures  was  so  in- 
tense and  so  abrupt  as  to  constitute  a  very  efficient  stimulus  so  that 
the  extreme  result  was  brought  about.  It  must  be  noted  however 
that  ultimately  further  adjustment  will  be  impossible  and  the  tissue 
must  respond.  Note  that  finally  the  hunch-back  succumbs  to  con- 
ditions much  less  severe  than  would  be  the  case  if  the  spine  were 
normal.  The  summation  of  stimuli  may  help  in  the  explanation  of 
such  conditions.  A  stimulus  ineffective  at  first,  by  repeated  opera- 
tion may  cause  such  an  accumulation  of  effect  as  to  result  in  a  dis- 
charge. The  evil  effects  of  the  abnormal  spinal  condition,  grad- 
ually and  constantly  active,  lower  the  resistance  of  the  entire  body 
and  finally  produce  a  summation  of  evils  with  resulting  disaster. 


Varying  Symptoms 

2.  Another  important  fact  that  must  be  noted  is  that  the 
region  of  apparent  disturbance  is  not  necessarily  or  usually  the 
seat  of  the  lesion.  While  this  statement  applies  with  more  force 
Lo  the  subjective  disturbance  of  pain  yet  it  is  noted  in  others  not 
subjective.  With  respect  to  pain,  it  is  sufficient  to  refer  to  a  later 
chapter  in  which  is  discussed  the  condition  of  transferred  pain. 
At  present  note  that  the  pain  caused  by  an  irritation  may  be  felt 
in  any  part  of  the  distribution  or  course  of  the  nerve  irritated.  In 
pressure  at  the  elbow  upon  the  ulna  pain  is  not  only  felt  at  that 
point  of  pressure  but  also  in  many  cases  most  markedly  in  the  fin- 
gers, i.  e.,  where  the  nerves  are  specially  developed  for  receiving 
stimuli.  A  lesion  in  the  spine  by  pressure  on  fibers  forming  the 
intercostals  may  produce  pain  felt  over  the  anterior  surface  of 
the  chest  or  abdomen.  Hilton's  rule  that  pain  felt  superficially 
and  not  accompanied  by  a  local  rise  in  temperature  indicates  a 
spinal  origin  of  the  pain,  is  interesting  and  helpful,  especially  to 
osteopaths.  Especially  is  this  likely  to  be  the  origin  if  the  pain  be 
symmetrical,  i.  e.,  on  both  sides  of  the  median  line  at  corresponding 


90  PRINCIPLES  OF  OSTEOPATHY 

points.  An  associated  local  rise  in  temperature  together  with  other 
evidences  of  local  inflammation  indicates  the  latter  as  the  probable 
immediate  irritant. 

Reflex  Effects 

But  the  application  can  be  made  to  no  other  than  pain  condi- 
tions. Note  that  a  pelvic  lesion  primarily  affecting  the  uterus  may 
cause  symptoms  only  with  the  heart,  palpitation  of  that  organ 
being  a  quite  common  result.  In  this  case  the  patient  and  physician 
would  naturally  assume  that  the  heart  was  primarily  at  fault.  But 
experience  suggests  that  it  is  otherwise,  the  heart  being  affected 
through  the  complicated  mechanism  of  reflex  activity.  The  im- 
pulses from  a  disturbed  uterus  are  carried  by  the  sensory  nerves  to 
the  centers  in  the  spinal  cord,  and  the  abnormal  action  of  these 
centers  affects  other  spinal  centers.  Impulses  from  these  disturbed 
centers  pass  by  way  of  the  gray  rami  fibers  and  the  sympathetic 
ganglia  to  the  heart  or  other  viscera.  But  why  should  the  heart 
be  thus  involved  and  not  some  other  organ?  In  answer  it  may  be 
said  that  in  other  cases  and  at  times  in  the  same  case  it  is  another 
organ.  Byron  Robinson's  suggestion  that  it  is  dependent  on  a  con- 
dition analogous  to  an  electric  arrangement  is  suggestive  but  un- 
satisfactory in  that  there  are  too  many  exceptions.  His  suggestion 
is  that  that  organ  will  be  involved  reflexly  which  is  connected  to  the 
primary  organ  by  the  greatest  number  of  nerve  strands.  Unfortu- 
nately he  does  not  show  that  such  is  the  case.  Personally  the  author 
prefers  another  explanation  in  which  there  are  noticed  few  excep- 
tions and  those  perhaps  only  apparent.  Under  the  circumstances 
of  a  perfectly  normal  condition  of  every  other  organ  of  the  body, 
little  disturbance  if  any  results  when  one  is  affected.  But  in  most 
eases  some  one  or  more  organs  are  in  an  irritable  state.  In  such  a 
case  a  nerve  impulse  coming  from  the  organ  primarily  involved  is 
an  effective  cause  of  perverted  function  in  the  irritable  organ. 
Hence  the  statement  may  be  made  after  this  manner:  that  organ 
will  be  involved  reflexly  which  is  in  the  more  irritable  condition. 
The  excess  of  irritability  in  one  organ  over  that  in  another  depends 
to  a  slight  extent  only  upon  inherent  capacity,  and  in  much  greater 
part  upon  a  disturbed  nutrition  dependent  on  an  associated  lesion. 
Ill  case  of  a  reflex  disorder,  then,  we  must  look  for  an  additional 
(^anse  in  the  way  of  predisposition.    In  the  majority  of  cases  exper- 


VARYING  EFFECTS  OF  LESIONS  91 

ience  shows  that  the  predisposition  results  from  a  lesion  in  the 
region  of  the  source  of  nutrition  for  the  organ.  Hence  in  case  of 
the  palpitation  resulting  from  uterine  disorder  a  lesion  should  be 
found  in  the  region  of  innervation  of  the  heart,  or  in  those  structures 
which  may  directly  affect  the  heart.  And  such  is  the  case.  The 
reflex  impulse  is  but  the  exciting  cause,  the  lesion  the  predisposing ; 
neither  alone  being  sufficient  to  destroy  the  cardiac  equilibrium 
but  acting  conjointly  they  are  able  so  to  do. 

It  is  a  question  whether  a  large  number  of  so  called  reflex  dis- 
orders should  be  considered  reflex  except  in  the  manner  suggested 
above.  The  occipital  headache  from  uterine  displacement  is  much 
more  likely  to  occur  if  there  be  a  local  lesion  deranging  the  ceph- 
alic circulation ;  the  headache  resulting  from  gastric  disorder  usually 
presents  cervical  lesions  sufficient  to  cause  the  disturbance  to  ap- 
pear; even  the  vomiting  of  pregnancy  is  often  in  direct  proportion 
to  the  abnormal  previous  condition  of  the  stomach.  Hence,  let  none 
rest  content  with  the  diagnosis  of  a  "reflex  effect."  Prove  that  the 
local  structural  conditions  are  normal  before  sentencing  the  reflex 
mechanism  as  the  sole  cause  for  the  disturbance. 


CHAPTER  XIX 

ABUSE  OF  FUNCTION 

Osteopaths  make  no  claim  that  there  are  no  possible  disease 
conditions  from  other  than  structural  perversions.  Any  one  will 
recognize  the  fact  that  by  abuse  of  any  organ  or  its  function  abnor- 
mal action  may  result.  Indeed  every  life  is  a  continued  fluctuation 
between  a  normal  and  an  abnormal  condition,  so  that  it  becomes 
evident  that  disease  is  but  a  relative  term.  If  a  continued  excess 
of  carbon  dioxid  in  the  blood  constitutes  a  disease,  shall  we  decide 
that  the  amount  necessary  to  arouse  increased  respiratory  activity 
is  a  disease?  That  condition  continues  for  an  appreciable  length 
of  time  and  in  so  far  as  it  does  it  is  a  normal  stimulus  to  the  respir- 
atory activity,  it  is  not  to  be  considered  disease.  The  organism  is 
able  to  adjust  its  functioning  immediately.  What  is  true  in  the  case 
of  respiration  is  true  of  the  body  as  a  whole.  The  struggle  between 
organism  and  environment  is  a  ceaseless  one  in  which  the  organism 
is  usually  triumphant,  but  there  are  times  when  abnormal  factors 
m  the  environment  temporarily  gain  the  supremacy.  In  these  cases 
enough  of  a  departure  from  normal  is  apparent  to  be  dignified  by 
the  term  disease.  It  is  this  condition  that  is  present  in  abuse  of  an 
organ  or  its  function.  Excess  of  food,  overwork  of  muscle,  contam- 
inated air,  all  represent  what  is  foreign  to  the  organism,  and  as 
such  stimulates  it  to  an  unusual  response.  In  the  vast  majority  of 
cases  the  organism  is  victor  though  no  external  aid  is  given.  At 
least  95  per  cent,  of  acute  cases  are  overcome  without  treatment  of 
any  kind.  In  such  cases  the  full  responsive  power  is  usually  exert- 
ed in  the  attempt  to  overcome.  If  the  stimulus  is  too  intense  or  pro- 
longed, death  results.  The  duty  of  the  physician  in  such  cases 
is  to  secure  and  maintain  such  a  condition  of  organism  and  environ- 
ment as  allows  the  fullest  freedom  to  the  responsive  power  of  the 
organism.  Of  prime  importance  in  this  connection  is  the  prevention 
and  overcoming  of  secondary  lesions.  This  with  additional  attention 
to  known  laws  of  hygiene  and  sanitation  usually  suffice  to  enable 
a  return  to  the  usual  grade  of  organic  action. 

Time  Relations 
The  abuse  that  causes  disease  may  be  overuse  in  time  relations. 
That  is.  the  organ  functioning  through  too  great  a  proportion  of 

92 


ABUSE  OF  FUNCTION  93 

the  allotted  time  to  allow  for  repair  will  ultimately  be  disturbed. 
This  disturbance  may  be  in  the  nature  of  a  hypertrophy.  An  over- 
used muscle  will  become  enlarged,  as  in  ease  of  the  heart  after 
valvular  disorder.  The  liver  in  an  individual  who  constantly  over- 
eats will  ultimately  be  somewhat  increased  in  size.  The  constant 
abuse  of  the  stomach  may  result  in  a  thickening  mucosa.  In  many 
of  these  cases  the  hypertrophy  is  in  part  physiological ;  for  instance 
the  hypertrophied  heart  is  a  necessity  under  the  existing  circum- 
stances, i.  e.,  the  inefficient  valve.  At  the  same  time  it  is  secured 
at  the  expense  of  a  continuous  tendency  toward  the  production  of 
disorder  in  neighboring  structures,  for  instance  impaired  respira- 
tion dependent  on  lung  pressure  from  the  enlarged  heart. 

Secondly,  exhaustion  is  a  common  result  from  abuse  in  point 
of  time.  In  the  case  of  the  enlarged  heart,  so  long  as  compensation  is 
maintained  little  difficulty  may  be  experienced,  but  usually  the 
time  comes  when  all  reserve  forces  have  been  drawn  upon,  the  heart 
is  no  longer  able  to  increase  its  substance  to  meet  the  increased  de- 
mands, and  exhaustion  of  its  energy  and  substance  rapidly  follows. 
The  gastric  glands,  continually  called  upon  to  do  excessive  work, 
finally  yield  to  the  inevitable  and  fail  to  supply  the  requisite  amount 
of  digestive  fluids.  In  any  of  these  cases  a  third  condition  is  likely 
to  result,  that  of  atrophy.  In  this  connection  note  the  wasting  of 
heart  muscle  during  the  period  of  broken  compensation,  the  thin- 
ning and  waste  of  substance  in  the  walls  of  the  stomach,  or  the 
final  condition  of  atrophy  and  degeneration  in  an  overworked  liver. 

Intensity 

Again  the  abuse  may  be  overuse  in  intensity.  Apoplexy  result- 
ing from  sudden  increase  in  blood  pressure  from  overexercise  of 
body  or  mind  is  a  case  in  point.  Aneurism  is  similarly  caused. 
Excessive  lifting,  athletic  efforts  and  the  like,  may  produce  strains 
and  ruptures  in  various  of  the  body  tissues.  This  is  not  limited  to 
those  cases  where  a  pre-existing  weakness  makes  the  sudden  strain 
effective,  as,  for  instance,  the  usual  arterio-sclerosis  in  those  indi- 
viduals subject  to  apoplectic  attacks;  but  where  the  strain  itself  is 
the  primary  and  perhaps  the  sole  causal  factor.  It  is  immaterial 
whether  the  predisposition  exists :  the  strain  is  an  abuse  under  any 
circumstances. 

Diminished  Functions 

Instead  of  overuse  constituting  the  abuse,  under  use  may  result 


94  PRINCIPLES  OF  OSTEOPATHY 

in  a  disorder.  It  is  a  well  known  fact  that  a  muscle  kept  inactive 
for  a  considerable  period  will  gradually  waste  away.  This  is  not 
true  of  muscle  only.  It  seems  to  be  a  fundamental  biological  law 
that  the  structure  unused  becomes  incapable  of  use,  and  if  certain 
theories  of  evolution  be  accepted  we  may  explain  the  gradual  dis- 
appearance of  structures  in  man  and  other  animals  on  the  basis  of 
disuse.  Note  in  the  case  of  the  lungs  of  an  individual  who  contracts 
"lazy  habits  of  breathing,"  that  they  are  much  more  susceptible 
to  disorders  than  are  those  of  him  who  breathes  naturally  and  deep- 
ly. The  apices  are  the  regions  of  lung  tissue  most  commonly  in- 
volved in  tuberculosis  and  they  are  involved  first  in  point  of  time. 
The  apex  is  the  least  exercised  of  all  parts.  The  two  facts  may 
be  closely  associated.  Again,  proteid  food  substances  furnish  a 
most  efficient  stimulus  to  the  secretion  of  pepsin  by  the  gastric 
glands.  The  consumption  of  predigested,  peptonized  foods  may 
constitute  a  definite  abuse  though  furnishing  lessened  exercise  of 
the  peptic  glands  with  a  consequent  atrophy  of  these  structures. 

Perversions 
Finally  reference  may  be  made  to  abuse  in  the  form  of  per- 
verted use  of  function.  The  teeth  are  structures  designed  to  grind 
the  food  materials.  If  that  function  is  given  to  the  stomach  through 
improper  mastication,  there  is  a  perverted  use  of  the  stomach.  Life 
in  an  environment  of  impure  air,  noxious  vapors,  and  dust  particles 
constitutes  an  abuse  of  the  respiratory  function.  According  to  the 
report  of  witnesses  in  the  recent  coal  strike  investigation  one  of 
the  causes  of  the  shortened  life  period  of  the  coal  miner  is  the 
continued  inhalation  of  coal  dust.  Post-mortems  of  those  who  have 
worked  for  long  periods  in  an  atmosphere  charged  with  metal  or 
other  particles  show  the  induration  of  the  lungs  from  deposit  of  the 
material  as  a  factor  in  the  cause  of  death.  Mouth  breathing  is  a 
perversion  and  is  accountable  for  occasional  disorders  of  the  res- 
piratory, or  upper  part  of  the  digestive  channel.  The  introduction 
into  the  body  through  any  pathway,  of  a  material  foreign  to  the 
organism  constitutes  a  perversion.  Hence,  drugs  taken  into  the 
alimentary  canal,  pathogenic  bacteria  with  their  toxins,  and  all 
other  forms  of  poisoning  constitute  abuse  conditions  in  the  nature 
of  perverted  use.  In  a  large  number  of  such  cases  the  cause  is  of 
an  exciting  character,  a  predisposition  being  present  which  impairs 
the  responsive  power  of  the  organism.  This  is  especially  true  of 
micro-organisms,  a  discussion  of  which  is  given  in  a  further  chapter. 


CHAPTER  XX 

PREDISPOSING  AND  EXCITING  CAUSES  OF  DISEASE 

The  causes  of  disease  may  further  be  classified  in  accordance 
with  their  relative  capacity  to  produce  disorder  without  the  aid  of 
any  other  factors,  predisposing  and  exciting.  This  classifica- 
tion is  not  an  absolute  one  but  may  be  used  with  advantage  for 
purposes  of  convenience  and  better  understanding.  A  predisposing 
cause  is  any  condition  of  the  organism  or  its  environment  which, 
while  not  producing  sufficient  disorder  to  constitute  disease,  renders 
the  organism  more  susceptible  to  other  causes.  As  illustrations  of 
such  may  be  mentioned  the  following;  In  hay  fever  two  conditions 
seem  to  be  essential  in  the  production  of  the  characteristic  symptom, 
an  irritable  condition  of  the  nasal  mucosa  and  a  specific  irritant, 
as  pollen  from  certain  plants,  dust  particles  and  the  like.  The  weak- 
ness is  more  or  less  continuously  present,  the  specific  irritant  only 
at  special  periods.  In  this  case  the  irritable  mucosa  with  whatever 
has  caused  that  condition,  as  a  lesion  in  the  cervical  region,  consti- 
tutes the  predisposing  cause,  the  pollen  or  dust  particles  represent- 
ing the  exciting  cause.  Neither  of  these  two  is  capable  alone  of 
producing  the  attack  but  acting  conjointly  are  sufficient.  The  small 
boy  is  noted  for  his  craving  for  green  apples.  If  a  lesion  be  present 
in  his  splanchnic  region  and  he  indulges  the  craving  only  moder- 
ately, an  attack  of  cholera  morbus  is  the  result.  In  this  ease  the 
green  apple  represents  the  final  aggravation  added  to  a  stomach 
already  weakened  from  vasomotor  disturbance  maintained  by  the 
splanchnic  lesion.  A  depressed  thoracic  region,  by  limiting  the  am- 
plitude of  the  respiratory  movements,  renders  the  lungs  less  able 
to  resist  tuberculosis  infection,  the  tubercle  bacillus  acting  as  the 
immediate  cause  of  pulmonary  consumption,  the  former  the  predis- 
position to  the  disorder.  Rigidity  of  the  lower  thoracic  area  of  the 
spinal  column  diminishes  resistance  to  infection,  and  correction  of 
this  lesion  increases  immunity.^  Pulmonary  troubles  tend  to  run 
in  families.  It  is  not  the  inheritance  of  the  specific  condition  but 
the  peculiarity  of  structure.  Most  reflex  disorders  are  satisfactorily 
explained  from  this  double  cause  standpoint.    For  instance,  a  com- 


ic.  A.   Whiting:      Opsonic    Index   as   Aflfeetcd   by   Mechanical   Stimulation, 
and  other  reports. 

95 


96  PRINCIPLES  OF  OSTEOPATHY 

mon  accompaniment  of  uterine  disorder  is  palpitation  of  the  heart. 
Such  a  disturbed  heart  rate  is  much  more  likely  in  an  individual 
with  a  spinal  lesion  in  the  cardiac  area  than  in  one  whose  heart 
control  is  not  interfered  with. 

Age,  sex,  temperament,  and  race,  relating  to  the  organism;  and 
climate,  season,  atmospheric  and  other  environmental  circumstances 
may  constitute  predisposing  causes  or  occasions.  It  is  common 
knowledge  that  children  are  more  susceptible  than  adults  to  measles 
or  scarlet  fever,  while  arterio-sclerosis,  paralysis  agitans,  and  num- 
erous other  disorders  affect  only  the  adult  or  aged.  The  peculiar 
condition  of  the  organism  at  these  different  periods  constitutes  a 
predisposition.  The  negro  race  is  more  susceptible  to  tuberculosis 
and  less  to  yellow  fever  and  malaria  than  is  the  Caucasian ;  and  this 
by  virtue  of  some  inherent  difference  in  the  organism  which  is 
without  satisfactory  explanation.  Climate  is  accountable  for  special 
disorders.  Catarrhal  affections  of  the  respiratory  tract  are  common 
in  cold,  damp,  and  changeable  localities,  while  typhoid  and  other 
fever  conditions  are  associated  with  late  summer  and  autumn,  in 
each  case  predisposing  to  the  onset  of  the  disease  through  the 
agency  of  various  exciting  stimuli. 

A  point  to  be  noted  in  this  connection  is  the  fact  of  what  may 
be  conveniently  spoken  of  as  a  reversibility  of  causes.  That  is,  a 
lesion  which  in  one  set  of  circumstances  constitutes  a  predisposition, 
may  in  another  be  an  excitant.  Note  the  case  in  hay  fever.  An 
individual  manifests  a  lesion  in  the  cervical  region  but  no  symptoms, 
until  the  season  when  pollen  is  plentiful,  when  the  attack  is  initiated. 
In  this  case  the  lesion  is  predisposing,  the  pollen  exciting,  to  the 
disorder.  Another  individual  continuously  living  in  a  pollen-laden 
atmosphere  is  unaffected  thereby.  But  a  lesion  is  produced,  when 
the  attack  at  once  supervenes.  Thus  predisposition  and  excitant 
have  been  reversed.  Climate  conditions  may  be  the  excitant  or  a 
predisposing  cause.  In  the  first  case  a  lesion  is  present  rendering 
the  nasal  tissues  susceptible  to  the  influence  of  sudden  changes 
of  temperature,  the  latter  being  the  excitant  of  the  disorder ;  on  the 
other  hand  an  individual  living  in  a  changeable  climate  is  predis- 
posed to  catarrhal  disorders  by  virtue  of  the  environment,  the 
catarrhal  condition  itself  being  excited  on  the  production  of  a  spe- 
cific lesion.  An  individual  with  a  normal  splanchnic  region  may 
continually  abuse  his  stomach  by  overeating  and  still  no  gastric 


PREDISPOSING  AND  EXCITING  CAUSES  OF  DISEASE  97 

disturbance  result,  but  on  the  production  of  a  lesion  disorder  soon 
becomes  manifest;  on  the  other  hand  an  individual  with  a  lesion 
in  his  splanchnic  region  may  show  no  marked  evidence  of  stomach 
trouble  but  on  abuse  of  his  stomach  by  dietetic  errors  disease  occurs. 

It  is  to  be  noted  further  that  while  a  predisposing  cause  of  dis- 
ease usually  is  not  sufficient  to  produce  the  disease,  an  excitement 
may  produce  it  with  or  without  the  addition  of  the  other  factor. 
While  it  is  much  more  likely  that  disease  will  result  from  the  eating 
of  green  apples  in  the  case  of  a  child  who  shows  specific  splanchnic 
lesion,  experience  would  indicate  that  the  green  apples  alone  are 
sometimes  an  efficient  cause. 

Finally  it  is  to  be  noted  that  in  a  large  number  of  disease  con- 
ditions of  any  permanency  in  time  they  are  dependent  not  on  a 
single  cause  but  upon  numerous  factors  in  which  numerous  lesions 
and  numerous  forms  of  abuse  may  be  concerned  in  the  various  rela- 
tions of  predisposition,  predisposing  occasions,  and  exciting  causes.^ 


^For  excellent  discussion  of  "Summation  of  Causes  in  Disease  and  Death" 
by  E.  E.  Booth,  Ph.  D.,  D.  O.,  see  October,  1902,  issue  of  Journal  of  the  Amer- 
ican   Osteopathic    Association. 


CHAPTER  XXI 

THE  GERM  THEORY  OF  DISEASE 

It  seems  proper  at  this  time  to  discuss  a  problem  in  relation  to 
disease  which  has  in  recent  years  assumed  extreme  importance. 
The  germ  theory  of  disease  is  not  at  all  a  new  explanation  of  disease 
conditions,  for  ever  since  the  invention  of  the  compound  microscope 
in  the  middle  of  the  seventeenth  century  the  fact  that  small  forms 
of  life  were  associated  with  certain  diseases  has  been  known; 
and  not  only  was  this  association  known  but  shortly  following  the 
discovery  of  micro-organisms  the  doctrine  of  a  causal  relation  be- 
tween such  micro-organisms  and  the  disease  was  promulgated,  and, 
as  suggested  by  Abbot,  amounted  almost  to  a  germ-mania.  But 
like  numerous  other  facts  and  theories  based  upon  those  facts  this 
was  practically  lost  sight  of  until  late  in  the  nineteenth  century 
when  it  was  again  revived  by  numerous  investigators  of  world  re- 
nown, among  whom  the  names  of  Pasteur,  Klebs  and  Koch  stand 
pre-eminent.  These,  with  others,  placed  the  theory  upon  fairly  sure 
ground  in  showing  by  methods  to  which  no  objections  could  be 
raised  that  in  certain  cases  there  is  such  a  definite  relation  between 
the  pathological  condition  and  the  presence  of  the  micro-organism. 
The  question  is  not  yet  entirely  settled  as  to  the  nature  of  that 
relation.  Is  the  disease  as  it  exists  responsible  for  the  presence  of 
the  micro-organism,  or  do  the  bacteria  produce  the  pathological 
condition?  In  accordance  with  these  two  ideas  the  micro-organisms 
have  been  classified  into  the  Saprophytic,  or  those  which  live  only 
upon  non-living  matter;  and  Pathogenic,  or  those  which  by  virtue 
of  some  deleterious  action  definitely  produce  the  disease  condition. 
Doctor  Still  has  insisted  that  all  are  of  the  former  class  and  com- 
pares them  to  buzzards  whose  function  in  the  larger  world  is  to 
render  dead  and  decaying  material  incapable  of  further  harm. 
This  view  is  further  supported  by  the  fact  that  certain  bacteria, 
usually  saprophytic,  become  pathogenic  under  certain  circumstances. 
For  example,  the  colon  bacillus  is  usually  harmless,  yet  when  asso- 
ciated with  the  typhoid  bacillus,  or  when  other  inflammatory  con- 
ditions are  present,  this  same  colon  bacillus  becomes  actively  path- 

98 


THE  GERM   THEORY  OF  DISEASE  99 

ogenic.  The  aineba  eoli  also  seems  almost  or  quite  harmless,  yet 
when  it  is  associated  with  other  causes  of  intestinal  disease,  becomes 
definitely  pathogenic. 

The  question  arises  as  to  the  manner  in  which  bacteria  act  to 
cause  disease  in  those  individuals  susceptible  to  invasion.  The 
effects  of  bacterial  action  may  be  either  local  or  constitutional, 
or,  usually,  both. 

Local  Effects 

Local  effects  may  be  either  mechanical  or  histological,  or  both. 

"Sometimes  masses  of  micro-organisms  more  or  less  completely 
occlude  small  blood-vessels  and  occasion  secondary  changes  in  the 
tissues  in  this  mechanical  way.  In  other  cases  the  obstruction  is 
incomplete,  but  occasions  thrombosis  in  the  blood-vessels  and  areas 
of  necrosis  in  the  region  thus  deprived  of  blood;  hemorrhagic  ex- 
travasations of  blood  are  not  uncommon  in  such  cases." 

"The  histological  changes  occasioned  by  bacteria  are  prolifer- 
ative and  destructive,  among  the  latter  being  various  degenerations 
and  necroses." 

"  It  would  seem  from  late  observations  that  the  exact  reaction 
following  the  primary  settling  of  an  infecting  microbe  depends  upon 
whether  it  is  able,  by  toxin  formation,  to  destroy  normal  oxidative 
processes,  in  which  case  necrosis  is  apt  to  occur,  or  to  act  primarily 
with  positive  chemotactic  power,  in  which  case  local  suppuration 
usually  appears."^ 

Constitutional  Effects 

The  constitutional  effects  of  bacterial  invasion  depend  upon  the 
production  of  poisonous  substances,  usually  by  the  bacteria,  but 
sometimes  by  the  tissues  injured  by  the  bacteria.  These  include 
several  typ€S. 

Ptomaines  are  produced  by  the  decomposition  of  the  media  in 
which  the  bacteria  grow.  They  are  not  specific,  and  they  do  not 
produce  antitoxins.     Their  chemical  structures  are  known. 

Exotoxins  are  soluble  and  diffusible  poisonous  substances  pro- 
duced by  bacterial  activities.  They  are  specific,  do  produce  anti- 
toxins, and  their  chemical  structure  has  not  yet  been  determined. 


'Stengel  and  Fox,  Textbook  of  Pathology,  1921. 


100  PRINCIPLES  OF  OSTEOPATHY 

Endotoxins  develop  within  the  bodies  of  bacteria,  and  do  not 
injure  the  body  of  the  host  until  the  bacteria  die,  when  the  degen- 
eration of  their  bodies  sets  the  endotoxins  free.  They  do  not  produce 
antitoxins,  as  a  rule;  their  chemical  structure  is  not  known. 

Bacterial  proteins  seem  to  make  up  the  entire  body  of  certain 
bacteria.    They  may  be  definitely  toxic.    Little  is  known  of  them. 

Immunity 

A  few  suggestions  regarding  the  nature  of  immunity  may  not 
be  out  of  place.  It  may  be  natural  or  acquired.  Neither  of  these 
is  to  be  considered  absolute,  and  immunity  may  be  broken  by  any 
one  of  many  abnormal  conditions. 

The  skin  and  mucous  membranes  of  the  body  give  structural 
immunity.  The  hydrochloric  acid  of  the  gastric  juice,  the  alkaline 
and  proteolytic  secretions  of  the  intestinal  juices  illustrate  the 
immunity  due  to  secretions.  The  flow  of  secretions  toward  the 
surface  of  the  body  is  a  factor  in  immunity.  The  increased  exuda- 
tion of  fluids,  as  in  coryza  and  enteritis,  illustrate  a  reaction  which 
increases  natural  immunity.  Species  immunity  is  found  abundantly, 
and  this  applies  to  the  host  as  well  as  to  the  invader.  One  type 
of  tuberculosis  is  found  in  fish,  but  cannot  be  given  to  any  mammal 
except  the  rabbit:  nor  can  fish  be  aflFected  by  human  tuberculosis. 
Man  is  susceptible  to  trypanosoma  gambiense,  but  not  to  trypano- 
some  naganae. 

Species  immunity  can  be  broken  in  many  cases.  Fowls  are  im- 
mune to  anthrax,  under  normal  conditions,  but  fowls  kept  at  low 
temperatures  by  Pasteur  became  susceptible  to  anthrax.  Frogs  are 
not  susceptible  to  anthrax,  under  their  normal  conditions,  but  when 
their  temperature  is  raised  to  35"  they  also  become  susceptible  to 
anthrax.  It  is  evident  that  it  is  not  the  infectious  agent  that  is 
modified,  but  the  resistance  of  the  fowl  and  the  frog,  by  tempera- 
lures  abnormal  to  them. 

Racial  immunity  probably  exists,  but  it  is  less  important  than  is 
commonly  supposed.  Many  facts  supposed  to  indicate  racial  immun- 
ity are  not  such,  but  certain  races  seem  to  be  exempt  because  of 
good  sanitation,  or  because  children  suffer  from  light  and  immuniz- 
ing attacks  of  the  disease,  or  because  severe  attacks  kill  off  suscep- 
tible individuals  in  childhood.     Even  after  due  allowance  has  been 


THE  GERM  THEORY  OF  DISEASE  101 

made  for  these,  and  other  related  facts,  there  still  seems  some  basis 
for  a  belief  in  racial  immunity.  In  animals  racial  differences  in  im- 
munity are  often  found.  The  culex  mosquito  rarely  harbors  malarial 
parasites.  Gray  rats  are  more  resistant  to  streptococcus  than  white 
rats;  field  mice  are  susceptible  to  glanders,  while  white  mice  are 
immune.  Instances  might  be  multiplied  indefinitely,  which  illus- 
trate the  peculiarities  of  immune  reactions,  and  which  show  how 
immunity  may  be  broken  by  various  abnormal  states  of  the  individ- 
uals subjected  to  infectious  agents. 

Individual  immunity  is  often  noted.  Even  during  great  epidem- 
ics a  comparatively  small  proportion  of  people  succumb  to  infection. 
The  great  number  of  "carriers"  illustrates  the  fact  that  not  only 
the  infectious  agent,  but  also  a  receptive  and  susceptible  host  must 
be  present  if  infectious  disease  is  to  occur. 

Inherited  immunity  may  be  noted  in  family  and  in  racial  immun- 
ity. Congenital  immunity  is  that  due  to  intrauterine  infection,  in 
which  the  foetus  suffers  the  disease,  or  it  may  be  due  to  a  transfer- 
ence of  maternal  immunity. 

Acquired  immunity  is  due  to  previous  infection,  and  to  any  one 
of  many  methods  of  conferring  immunity  without  having  suffered 
from  the  disease  in  a  serious  form.  Immunity  may  be  conferred  by 
a  light  attack  of  the  disease ;  by  voluntary  infection  with  an  atten- 
uated virus ;  by  infection  with  dead  bacteria ;  by  the  use  of  the  bac- 
terial products.  Immunity  may  be  produced  to  certain  poisons  pro- 
duced by  animal  life,  as  snake  venom,  and  by  vegetables,  as  riein, 
abrin,  crotin,  and  other  poisons.  Not  all  poisons  produce  neutraliz- 
ing anti-bodies,  but  a  number  of  the  more  virulent  have  been  found 
to  do  so. 

Passive  immunity  may  be  secured  through  the  use  of  other  ani- 
mals. The  horse,  for  example,  produces  antitoxin,  which  is  much 
used  in  the  treatment  of  diphtheria.  Passive  immunity  carries  with 
it  certain  dangers,  and  is  only  safe  in  the  hands  of  experienced  and 
efficient  physicians.  The  dangers  include  poisoning,  other  infec- 
tions, anaphylaxis,  and  other  serious  conditions,  except  when  the 
method  is  employed  with  accuracy  and  skill.  Even  then,  the  method 
can  only  be  said  to  be  less  harmful  than  are  methods  previously 
employed  by  medical  physicians. 

After  considering  these  facts,  it  is  evident  that  the  micro-organ- 
ism is  not  the  sole  cause  of  any  disease.    It  must  find  its  hospitable 


102  PRINCIPLES  OF  OSTEOPATHY 

abiding  place,  and  must  be  allowed  to  remain  unmolested  there;  a 
condition  not  often  possible  in  the  normal  human  body.  Note  the 
significance  of  the  following  statement:  "Under  careful  precau- 
tions against  which  no  objections  could  be  raised  the  experiments 
of  Billroth  and  Tiegel  were  repeated  by  Pasteur,  Burdon-Sander- 
son,  and  Klebs,  but  with  the  failure  in  every  instance  to  demonstrate 
the  presence  of  bacteria  in  the  healthy,  living  tissue."^  In  a  few 
instances,  bacteria  seem  able  to  invade  bodies  of  people  who  seem 
to  be  healthy.  The  gonococcus  finds  lodgment  upon  mucous  mem- 
brane, lives  there,  and  ultimately  sets  up  destructive  inflammations, 
invades  the  injured  tissues,  and  produces  characteristic  symptoms, 
[t  must  be  noted  that  such  invasions  begin  with  lodgment  and 
destruction  of  the  neighboring  cells;  the  gonococcus  does  not  act- 
ually invade  the  membrane  until  that  membrane  has  been  injured. 
Other  apparent  exceptions  can  be  found,  but  the  statement  is  sub- 
stantially accurate,  that  bacteria  do  not  produce  disease,  and  do  not 
exist,  within  healthy  tissues. 

Why  are  they  not  present  within  healthy,  living  tissue?  We 
believe  the  only  answer  possible  is  that  absolutely  healthy  tissue 
is  incompatable  with  the  propagation  of  the  bacterium.  Nancrede 
emphasizes  this  fact  when  he  says,  "Such  healing  is  only  possible 
m  the  absence  of  infection,  mark  you,  not  the  absence  of  germs, 
because  as  we  shall  learn,  microbes  may  be  present,  but  unable  to 
multiply  and  interfere  with  the  normal  processes  for  reasons  which 
will  be  studied  later. "^  The  following  facts  are  also  significant;  in 
any  epidemic  of  diphtheria  there  is  little  difficulty  in  demonstrating 
the  presence,  in  the  pharyngeal  mucous  membrane  of  normal  indi- 
viduals, of  the  Klebs-Loeffler  bacillus;  the  micrococcus  lanceolatus 
is  present  in  the  sputum  or  in  the  saliva  of  many  individuals  not 
affected  with  pneumonia;  even  in  epidemics  of  Cholera  Asiatica 
unaffected  individuals  may  show  the  presence  of  the  comma  ba- 
cillus of  Koch  in  the  mucus  of  the  intestinal  canal.  Why  are  not 
these  affected?  Why  is  not  every  individual  stricken  with  the  dis- 
ease during  an  epidemic?  The  only  possible  answer  is  that  they 
are  immune  and  immunity  proves  nothing  less  than  that  the  bac- 
terium cannot  be  a  sufficient  cause  of  disorder. 

"The  disease-producing  character  of  bacteria,  their  virulence, 

^Abbot:      Principles   of   Bacteriology. 
^Nancrede:      Principles   of   Surgery. 


THE  GERM  THEORY  OF  DISEASE  103 

depends  upon  several  factors,  which  are  subject  to  modifications. 
Virulence  does  not  depend  entirely  upon  the  characteristics  of  the 
infectious  agent,  because  the  production  of  disease  is  an  exhibition 
of  reaction  between  invading  organism  and  host.  We  may,  there- 
fore, say  that  virulence  depends  upon  two  groups  of  factors,  those 
inherent  in  the  invading  organism  and  those  dependent  upon  the 
resistance  exhibited  by  the  attacked  individual." 

"The  studies  of  pathogenic  bacteria  have  shown  that  they  ac- 
quire or  in  certain  instances  may  lose  virulence  by  passage  through 
animals,  and  that  they  may  lose  virulence  by  cultivation  upon  arti- 
ficial media."  They  may  acquire  increased  virulence  by  cultivation 
apon  artificial  media  to  which  animal  tissues  or  extracts  have  been 
added,  and  this  increased  virulence  may  be  specific  for  certain 
types  of  animals  alone/ 


^Karsner   and   Ecker:      Principles   of  Immunity,   1921. 


CHAPTER  XXII 

METHODS  OF  PROTECTION  AGAINST  BACTERIA 

The  methods  by  which  the  body  protects  itself  against  bacterial 
invasion  may  be  briefly  considered.  The  first  is  phagocytic  action, 
as  suggested  by  Sternberg  and  later  established  by  Metchnikoff. 
This  consists  in  the  action  of  the  neutrophiles  and  eosinophiles  of 
the  blood;  the  endothelial  cells,  which  may  also  be  found  in  the 
biood  at  times;  and  the  pulp  cells  of  the  spleen  and  lymph  nodes. 
Connective  tissue  cells,  including  bone  cells,  striated  muscle  cells 
and  giant  cells  may  at  times  be  vigorously  phagocytic. 

"The  process  of  phagocytosis  involves  three  steps,  first  the  ap- 
proach of  the  cell  and  the  material  to  be  taken  up;  second  the 
ingestion  of  the  material,  and  third,  the  destruction  of  such  material 
as  may  be  dissolved  by  the  digestive  fluids  of  the  cell."  (Karsner 
and  Ecker.)  The  approach  is  due  to  chemotaxis,  and  this  may  be 
exemplified  in  drops  of  mercury,  etc.,  under  various  chemical  and 
physical  conditions.  The  ingestion  of  the  foreign  body  by  the  cell 
is  secured  by  the  protrusion  of  pseudopodia  by  the  cell,  and  these 
pseudopodia  encircle  the  object,  meet,  fuse  and  surround  it;  the 
cell  protoplasm  flows  around  and  over  the  body,  and  thus  encloses 
it  completely.  This  phase  also  is  easily  reduplicated  in  non-living 
materials. 

Digestion  of  the  foreign  body,  if  it  is  digestible,  is  accomplished 
by  means  of  secretions  from  the  protoplasm  of  the  cell.  This  fluid 
is  usually  slightly  more  acid  than  the  cell  protoplasm,  and  it  con- 
tains proteolytic  enzymes,  which  have,  in  certain  cases,  been  isolated 
from  digesting  cells.  If  indigestible  materials  have  been  ingested, 
they  may  remain  indefinitely;  or  may  be  extruded,  or  may  cause 
the  death  of  the  cell. 

Phagocytosis  is  facilitated  by  opsonins.  These  bodies  are  present 
in  normal  blood  plasma,  and  they  are  greatly  increased  during  bac- 
terial invasion.  They  are  specific  for  each  organism,  and  sometimes 
for  any  one  strain  of  an  organism. 

Leucocytes  produce  also  substances  which  destroy  bacteria.  Ex- 
tracts made  from  blood  and  exudates  are  definitely  bactericidal  and 

104 


METHODS  OF   PROTECTION  AGAINST  BACTERIA  105 

are  often  specific  for  the  bacteria  causing  the  exudate  or  the  leu- 
eoeytosis.  A  leucocytic  antibody  has  been  described.  Several  dif- 
ferent enzymes  may  be  extracted  from  leucocytes  which  destroy 
dead  bacteria,  but  are  not  bactericidal. 

The  lymphocytes  which  surround  injured  or  invaded  areas  pro- 
duce enzymes;  their  action  is  not  well  understood.  Their  lipase 
may  be  very  important  in  the  digestion  of  the  fatty  capsule  of  the 
tubercle  bacillus.  They  seem  also  to  form  a  part  of  the  cancer- 
protective  mechanism  of  the  body. 

Blood  platelets  often  surround  bacteria,  and  this  may  interfere 
with  their  destructive  action. 

Local  inflammatory  changes  are  often  efficient  guards  against 
further  infection.  The  increased  temperature  aids  in  phagocytosis; 
the  accumulation  of  leucocytes  and  lymphocytes  produces  enzymes 
and  various  destructive  agents  for  the  bacteria;  the  connective 
tissue  increase  and  the  deposit  of  fibrin  tend  to  wall  off  the  diseased 
areas  and  prevent  the  spread  of  infection. 

Antitoxins  and  antibodies  are  produced  quickly  when  active  in- 
fection occurs.  Antibodies  are  produced  to  some  extent  in  the 
locality  invaded.  The  lymphatic  nodes,  the  spleen,  the  liver  and 
the  bone  marrow  seem  to  be  the  most  important  organs  for  the 
manufacture  of  anti-bodies. 

The  mechanism  of  recovery  from  diseases  associated  with  bac- 
ccrial  invasion  is  of  interest.  Many  experiments  have  been  per- 
formed which  show  beyond  question,  from  whatever  aspect  the 
tests  are  considered,  that  bodies  which  are  the  more  nearly  struc- 
turally correct,  make  the  most  speedy  and  complete  recovery;  and 
that  anything  which  disturbs  the  structure  of  the  body,  or  which 
interferes  with  its  functional  integrity,  interferes  also  with  recovery. 

Normal  circulation  of  normal  blood  seems,  after  all  facts  have 
been  considered,  to  be  the  most  important  factor  in  promoting  re- 
covery. 

In  general,  then,  we  arrive  at  the  conclusion  to  which  the  old 
school  physicians  must  come  and  in  goodly  number  are  already 
coming,  that  first,  assuming  that  certain  micro-organisms  in  suffi- 
cient number  may  initiate  disorder  and  may  be  able  to  gain  access 
to  the  body  substance,  vitiated  tissue  is  almost  always  a  necessary 
prerequisite  before  the  bacterium  can  excite  the  specific  disorder, 


106  PRINCIPLES  OF  OSTEOPATHY 

and  that  second,  the  treatment  must  include  methods  to  overcome 
the  cause  of  the  vitiated  tissue — which  is  usually  a  lesion  or  abuse 
— and  to  assist  the  organism  in  keeping  up  its  strength  to  overcome 
the  bacterium  or  its  products  which  constitute  the  exciting  cause. 
The  usual  methods  for  the  destruction  of  bacteria  known  to  be 
potentially  pathogenic,  and  the  usual  sanitary  provisions,  are,  of 
course,  employed  in  all  cases  of  infection. 

It  would  seem  therefore  that  the  anathemas  hurled  at  the  germ 
theory  advocates  by  certain  osteopaths  are  entirely  uncalled  for. 
The  position  of  osteopathy  is  impregnable  regardless  of  the  ultimate 
demonstration  of  the  exact  relation  between  bacteria  and  disease. 
If  it  be  shown  that  all  such  micro-organisms  are  simply  associated 
and  not  causal  factors,  well  and  good.  If  the  causal  relation  be 
established,  it  is  no  more  true  of  them  than  of  numerous  other  ele- 
ments of  environment,  that  they  may  promote  disease.  Continued 
life  in  an  atmosphere  of  dust  certainly  will  cause  disorder  through 
abuse  of  the  organs  of  respiration.  An  environment  of  excessive 
microscopic  life  constitutes  an  abusing  factor  in  the  same  way.  The 
organism  will  be  successful,  so  far  as  success  is  at  all  possible,  as 
long  as  the  machinery  through  which  life  manifests  itself  is  kept 
in  its  structural  integrity,  and  so  long  as  the  environment  and  abuse 
conditions  do  not  exceed  the  limits  of  normal  adaption. 


CHAPTER  XXIII 

THE  DIAGNOSIS  OF  DISEASE 
The  Symptom 

Diagnosis  consists  in  the  determination  of  the  location  and  nature 
of  disturbed  conditions.  The  osteopath  recognizes  the  value  of 
symptoms  in  that  diagnosis.  A  symptom  or  a  group  of  symptoms 
does  not  constitute  disease  but  is  only  the  evidence  that  disease 
exists.  To  treat  the  symptoms  as  they  arise,  and  this  only,  is  a  rule 
of  practice  which  implies  the  confession  of  failure  to  trace  the  symp- 
tom to  its  cause.  It  is  only  in  occasional  cases  that  it  is  necessary  or 
admisable  to  treat  symptoms  and  even  that  is  but  incidental.  The 
symptom  is  an  effect — a  logical,  and  under  the  circumstances  a  legiti- 
mate physiological  effect.  It  is  as  much  a  matter  of  physiology  that 
the  heart  rate  should  be  increased  when  peripheral  resistance  is  at 
fault  as  that  the  heart  should  maintain  a  normal  rate  under  normal 
conditions  of  peripheral  resistance.  Pain  is  a  physiological  condition 
under  the  circumstances  of  pressure  or  other  cause  of  sensory  irri- 
tation, and  it  is  noticeably  true  of  pain  that  by  its  presence  protec- 
tion to  the  organism  is  secured.  In  the  first  place  pain  is  a  warning 
to  the  consciousness  of  the  individual  that  something  is  wrong; 
second,  the  location  of  the  pain  together  with  the  transference  of 
the  sensation  gives  fairly  accurate  location  of  the  disturbance ;  third, 
pain  in  numerous  cases  enforces  rest,  thereby  securing  better  oppor- 
tunity for  organic  repair;  and  fourth,  the  pain  condition  by  caus- 
ing directly,  indirectly,  or  reflexly,  increased  activity  of  other  parts 
of  the  body  may  further  aid  in  processes  of  repair. 

Fever 

The  high  temperature  of  fever  is  a  condition  that  in  some  respects 
is  directly  advantageous  to  the  organism.  It  is  known  that  in  num- 
erous febrile  states  certain  pathogenic  micro-organisms  play  an  im- 
portant role,  not  necessarily  in  acting  as  the  original  cause  of  the 
disorder,  but  at  least  in  complicating  the  condition.  By  laboratory 
experiment  and  clinical  observation  it  is  found  that  with  many 

107 


108  PRINCIPLES  OF  OSTEOPATHY 

forms  of  bacteria  a  high  temperature  is  directly  antagonistic  to  their 
development.  Hence  the  high  temperature,  while  a  distinct  symp- 
tom of  disorder,  is  in  addition  a  definite  protection  to  the  individual. 
The  profuse  sweat  which  is  often  associated  with  fever  cases  is  an 
arrangement  whereby  a  temporary  respite  is  given  to  the  patient 
from  the  great  discomfort  due  to  the  temperature.  In  the  evapor- 
ation of  the  perspiration  the  patient  is  temporarily  relieved.  The 
chill,  also  often  found  in  connection  with  various  acute  cases,  rep- 
resents a  physiological  principle.  If  a  case  of  malarial  fever  be 
examined  just  at  the  beginning  of  the  period  of  the  chill,  it  will 
be  found  that  the  temperature  of  the  body  is  near  the  normal.  If 
observation  be  made  shortly  after  the  chill  period,  or  even  before 
that  period  ceases,  a  considerable  increase  in  the  temperature  will 
be  noted.  Hence,  the  chill  is  a  method  for  increased  heat  produc- 
tion— a  thing  very  helpful  under  the  circumstances.  We  know 
that  most  of  the  body  heat  results  from  oxidation  processes  taking 
place  in  active  muscle  tissue.  In  the  chill  we  have  a  rapid  con- 
traction and  relaxation  of  the  muscle  tissues  of  the  body  with  the 
consequent  elaboration  of  heat.  Since  the  chill  is  but  an  exaggera- 
tion of  the  shiver,  the  explanation  of  the  increase  in  temperature 
becomes  obvious.  In  the  convulsion  we  have  still  another  condition 
where  it  is  probably  true  that  a  physiological  purpose  is  fulfilled. 
Dr.  Still  has  repeatedly  emphasized  his  conviction  that  the  muscu- 
lar spasm  is  but  nature's  effort  to  produce  a  redistribution  of  the 
forces  and  fluids.  Note  the  extreme  quiet  that  follows  the  epileptic 
spasm.  For  several  hours  there  is  deep  sleep  during  which  recuper- 
ation is  in  progress. 

Digestive  Reactions 

Vomiting  and  diarrhoea  are  symptoms  indicating  that  there  is 
disturbance  to  the  nerve  terminals  in  the  digestive  tract.  But  both 
are  physiological.  By  the  vomiting  process  the  organism  rids  itself 
oC  material  which  if  allowed  to  pass  into  the  intestinal  canal  would 
create  further  disorder;  while  the  rapid  peristalsis  associated  with 
the  diarrhoea  carries  onward  material  which,  having  gained  entrance 
to  the  canal,  is  directly  irritant.  By  this  increased  motion,  absorp- 
tion of  the  irritating  substance  is  materially  lessened,  and  hence  a 
definite  protection  is  provided.  The  anorexia  which  is  likely  to  be 
associated  with  both  of  these  conditions,  is  a  distinct  protection  in 


THE  DIAGNOSIS  OF  DISEASE  109 

that  it  militates  against  taking  into  the  alimentary  canal  additional 
material  before  the  canal  has  cleansed  itself  of  the  irritant  and 
before  the  assimilative  processes  are  again  in  condition  to  function 
properly.  In  such  a  case,  the  absence  of  desire  for  food  should  be 
suflScient  warning  to  refrain  from  partaking.  The  warning  is  often 
increased  by  a  definite  nausea  which  is  produced  by  the  mere  sight 
or  thought  of  food.  Needless  to  say,  the  warning  should  be  heeded, 
and  yet  as  a  result  of  years  of  false  teaching,  there  are  many  who 
utterly  ignore  the  warning  and  insist  on  forcing  food  upon  a  prop- 
erly rebellious  stomach. 

Pulmonary  Reactions 

The  rapid  respiration  in  pneumonia  is  another  typical  symptom. 
It  undoubtedly  is  a  favorable  condition  under  the  circumstances. 
For  in  this  disorder  one  lobe  of  the  lung  becomes  incapacitated  be- 
cause of  an  infiltration  into  the  air  sacs  and  bronchioles  of  a  material 
through  which  air  cannot  pass.  As  a  result  the  lobe  becomes  solid- 
ified and  comparatively  little  movement  is  possible.  But  the  de- 
mand for  oxygen  is  just  as  great  as  before ;  hence,  in  order  to  keep 
up  a  proper  supply  other  parts  of  the  lung  must  be  overactive. 
Thus,  by  this  hyperactivity  the  organism  is  protected  against  a 
deficiency  of  oxygen  that  would  otherwise  result.  In  a  similar  man- 
ner increased  activity  of  the  heart  muscle  is  called  for  when  a  valv- 
ular deficiency  occurs.  In  order  to  keep  up  a  normal  circulation 
with  deficient  valves  there  must  be  an  exaggerated  heart  action. 
Clinical  experience  shows  this  to  be  the  case.  And  not  only  does 
the  heart  increase  in  rapidity  but  it  also  increases  in  substance — 
purely  a  matter  of  accomodation  resulting  from  the  excess  of  action. 
Hence  hypertrophy  of  the  heart,  while  a  symptom  of  organic  car- 
diac disorder,  is  also  a  definite  protection  against  failure  of  the 
circulation — an  evil  much  greater  than  an  enlarged  heart. 

Glycosuria 

Glycosuria  as  found  in  diabetes  is  a  definite  symptom  of  pancre- 
atic disorder.  It  ought  to  be  present  in  such  a  case.  In  fact  the 
rather  abrupt  cessation  of  this  symptom  in  a  serious  case  of  disease 
is  a  cause  for  alarm.  When  the  sugar  begins  to  accumulate  in  the 
blood  it  is  the  function  of  the  kidney  to  throw  it  out.  The  failure 
of  the  kidney  to  excrete  is  cause  for  alarm.     Associated  with  the 


1  10  PRINCIPLES  OF  OSTEOPATHY 

excess  of  sugar  in  the  urine  there  is  an  increased  quantity  of  the 
latter  excreted — as  much  as  twenty  pints  or  more  having  been  noted. 
Under  the  circumstances  this  is  necessary.  In  order  to  keep  the 
excess  of  sugar  in  solution,  fluid  must  be  supplied.  The  greater 
the  amount  of  sugar  present,  the  greater  is  the  amount  of  water 
excreted  with  it  to  hold  it  in  solution.  In  this  case  the  symptom  is 
an  undoubted  protection.^ 

Inflammation 

In  many  inflammatory  conditions  there  are  certain  appearances 
which  suggest  a  definite  protective  action.  It  has  been  asserted 
with  a  good  degree  of  evidence  that  the  serous  exudate  in  an 
inflamed  area  is  a  factor  that  tends  to  reduce  the  pain  condition 
and  assist  in  the  healing  process.  In  the  case  of  an  inflammation 
of  a  mucous  surface,  as  in  all  catarrhal  conditions,  there  is  an  excess 
of  mucus  secreted.  The  excessive  blowing  of  the  nose  in  an  ordinary 
acute  nasal  catarrh  is  a  detriment  from  the  increased  irritation  thus 
caused.  The  exudate  should  be  permitted  to  remain  in  contact 
with  the  mucosa,  and  to  flow  gently  outward.  In  croupous  inflam- 
mations such  as  diphtheria,  the  removal  of  the  membrane  is  decid- 
edly contraindicated,  unless  it  forms  so  rapidly  and  in  such  amount 
as  to  offer  serious  obstruction  to  respiration.  It  is  undoubtedly, 
as  indicated  by  clinical  experience  and  by  abstract  reason,  a  real 
protection  to  the  injured  surface. 

Cases  might  be  multiplied  indefinitely  where  a  peculiar  appear- 
ance usually  mentioned  as  a  symptom,  is  not  only  the  latter,  but 
also  is  a  protective  means  employed  by  nature.  Not  that  every 
symptom  is  necessarily  a  benefit  to  the  organism  or  that  it  is  evi- 
dence that  the  latter  is  making  the  attempt  to  overcome  the  dis- 
order. In  fact  we  know  that  to  all  appearances  there  are  certain 
secondary  changes  that  arise  which  are  a  disadvantage  to  the  organ- 
ism. But  there  are  certainly  enough  cases  where  a  real  benefit  is 
derived  to  warrant  the  greatest  of  care  in  determining  whether  a 


^Disturbances  in  sugar  metabolism  are  produced  by  lesions  of  the  tenth 
thoracic  vertebrae  and  neighboring  tissues.  Such  disturbances  lead  first  to 
lowering  of  the  sugar  tolerence,  and,  later,  to  definite  diabetic  symptoms. 
For  accounts  of  the  experiments  upon  which  this  statement  is  based,  see  the 
Bulletins  of  the  A.  T.  Still  Research  Institute. 

For  discussions  of  the  chemistry  and  the  physiological  mechanism  of  var- 
iations in  sugar  metabolism  and  diabetes,  see  Wells,  Chemical  Pathology,  1918. 


THE  DIAGNOSIS  OF  DISEASE  HI 

symptom  should  be  combated.  Certain  it  is  that  the  rule  of  prac- 
tice to  "treat  the  symptoms  as  they  arise"  without  first  determin- 
ing the  usefulness  or  the  harmfulness  of  such  symptoms,  is  most 
reprehensible  and  has  no  place  in  the  philosophy  or  practice  of  the 
osteopath. 

WTiile  it  is  thus  true  that  in  many  cases  the  symptom  has  a 
deJBnite  value  aside  from  the  fact  that  it  is  a  key  to  the  nature  and 
location  of  the  disease,  it  is  with  reference  to  this  latter  considera- 
tion that  the  physician  finds  it  of  decided  practical  value.  Disease 
in  large  part  is  determined  by  symptoms,  and  we  may  define  a 
symptom  as  any  unusual  manifestation  in  structure  or  function 
that  suggests  disease.  The  symptom,  in  case  it  is  one  noted  only 
in  the  sensations  of  the  patient,  may  be  subjective,  or  where  noted 
by  physician  or  other  observer,  is  objective.  As  an  instance  of  the 
former,  pain  is  typical ;  of  the  latter  the  coated  tongue  in  digestive 
disturbances,  the  contracted  muscle  in  spinal  lesions,  or  albumin- 
aria  in  nephritis. 

Of  the  classes  of  symptoms,  subjective  and  objective,  the  latter 
is  the  one  relied  upon  for  determining  the  details;  the  former, 
although  customarily  first  used  in  point  of  time,  is  unsatisfactory. 
This  is  true  because  the  subjective  symptoms  are  subjective.  Feel- 
ings are  unreliable  signs.  The  location  of  the  disorder  may  be  far 
remote  from  that  which  is  apparently  indicated  by  the  sensation. 
The  further  fact  that  in  numerous  cases  patients  are  unable  to  locate 
the  sensation  or  are  unable  to  give  an  accurate  description  of  its 
nature,  increases  the  difficulty  in  the  way  of  a  satisfactory  diagnosis 
from  subjective  symptoms.  On  the  other  hand  the  conditions  that 
can  be  seen  and  felt  objectively  by  the  physician  constitute  fairly 
accurate  indications  of  the  disorder,  while  the  tenderness  on  pressure 
which  is  manifest  on  physical  examination  gives  quite  accurate 
data  for  legitimate  conclusions. 


CHAPTER  XXIV 

METHODS  OF  EXAMINATION 

The  methods  of  examination  objectively  are  those  in  use  by 
physicians  of  all  schools,  although  the  osteopath  emphasizes  one, 
palpation,  above  all  others.  First  in  point  of  time  is  the  method 
by  inspection,  which  consists  in  observing  various  changes  in  the 
appearance  of  the  body,  its  function  and  its  products,  by  the  sense 
ol  sight  aided  in  numerous  cases  by  the  microscope,  the  test  tube. 
X-ray  plates,  or  other  apparatus;  for  instance,  a  coated  tongue,  a 
sallow  complexion,  and  a  high-colored  urine  are  seen;  by  inspection 
lesions  are  determined,  at  least  in  general,  as  in  the  case  of  the 
carriage  of  the  head  in  torticollis,  the  inversion  of  the  toe  in  a 
dorsum  dislocation  of  the  hip,  or  a  contracted  muscle  and  deviated 
spinous  process  in  a  spinal  disorder. 

Palpation 

Palpation  is  the  second  method  in  point  of  time  but  first  in 
point  of  importance  and  consists  in  determining  conditions  by  the 
sense  of  touch.  For  instance,  by  palpation  we  may  note  an  in- 
creased cardiac  impulse,  a  difference  in  the  respiratory  movement 
of  the  two  sides  of  the  chest,  a  tumor  of  the  abdomen,  a  high  tem- 
perature in  fever  conditions,  a  contracted  muscle,  a  subluxated  rib, 
or  a  limited  movement  in  articular  structures,  and  by  pressure  upon 
a  part,  though  not  by  the  sense  of  touch  of  the  diagnostican,  differ- 
ences in  sensory  conditions  of  the  patient  may  be  determined.  Os- 
teopaths pride  themselves  upon  the  delicacy  of  their  sense  of  touch 
and  it  is  well  they  should,  because  by  no  method  can  the  lesion  be 
determined  so  satisfactorily'^  or  certainly  as  by  palpation.  If  one 
of  the  various  methods  should  be  developed  at  the  expense  of  others 
that  one  is  palpation.  It  is  characteristic  of  the  founder  of  osteop- 
athy that  he  made  use  of  palpation  almost  to  the  exclusion  of 
other  methods,  and  his  ability  to  detect  structural  changes  with  little 
difficulty  by  the  sense  of  touch  was  common  knowledge.  That 
there  is  large  possibility  of  developing  that  sense  will  be  admitted 
by  all,  but  to  the  osteopathic  practitioner  the  fact  becomes  more 

112 


METHODS  OF   EXAMINATION  113 

and  more  striking  as  his  experience  and  observation  extend  over 
a  larger  period  and  a  wider  field. 

Percussion 

A  third  method  of  objective  diagnosis  is  percussion.  This  con- 
sists in  the  comparison  between  the  sounds  produced  by  a  series  of 
light  blows  over  the  normal  and  abnormal  organ.  Every  organ 
or  structure  has  its  specific  percussion  note  which  is  determined 
by  its  density  and  its  relation  to  adjacent  structures  or  cavities 
which  act  as  sounding  boards  or  resonance  chambers.  Various 
names  are  given  to  the  different  grades  and  tones  of  the  percussion 
note ;  thus  we  speak  of  the  resonant  note  of  the  normal  lung,  the 
dull  note  of  the  liver,  the  flat  note  of  abdominal  dropsy,  or  the 
tympanitic  note  of  the  stomach  distended  with  gas.  The  methods 
of  percussion  are  immediate  (direct),  or  mediate  (indirect),  in  the 
former  of  which  light  blows  with  the  fingers  or  a  small  mallet  are 
delivered  directly  on  or  over  the  tissue;  in  the  latter,  which  is  most 
commonly  used,  a  pleximeter  is  interposed  betwen  the  structures 
percussed  and  the  fingers  or  mallet. 

Auscultation 

By  auscultation  the  sense  of  hearing  enables  the  physician  to  de- 
termine disordered  conditions  of  various  of  the  organs,  though  by 
this  method  the  sounds  produced  by  the  organs  in  their  functioning 
furnish  the  evidence.  A  change  from  the  usual  nature  of  the  sounds 
of  the  heart  is  indicative  of  cardiac  disorder;  the  respiratory  mur- 
mur gives  evidence  of  a  normal  or  abnormal  condition ;  the  rumbling 
sounds  produced  in  the  intestines  technically  spoken  of  as  borbory- 
gmus  suggest  overactive  gaseous  formation,  or  the  friction  sounds 
produced  by  the  approximated  pleural  layers  denote  the  dry  form 
of  pleuritis.  • 

Mensuration 

Mensuration  is  a  method  much  employed  by  osteopaths,  not  only 
in  the  way  of  definite  tape-line  measurement,  which  is  often  helpful 
and  occasionally  essential,  but  by  comparison  in  size  and  shape  of 
paired  or  symmetrical  structures.  The  difference  in  size  between 
the  sides  of  the  chest  is  often  noticed;  the  difference  in  the  width 


}  14  PRINCIPLES  OF  OSTEOPATHY 

of  the  ilio-costal  spaces  is  valuable  in  numerous  cases;  the  shorten- 
ing of  a  lower  limb  through  lesion  at  the  hip  or  pelvis  is  noted  by 
measurement  or  comparison;  the  increased  circumference  of  the 
shoulder  joint  is  diagnostic  of  a  dislocated  shoulder. 

Instruments 

For  certain  cases,  many  other  methods  may  be  employed.  The 
thermometer  gives  accurate  determination  of  temperature;  the 
sphygmomanometer  gives  blood-pressure  accurately;  the  sphygmo- 
graph  gives  accurate  information  as  to  valvular  conditions  of  the 
heart;  various  instruments  for  illuminating  and  exposing  to  view 
the  naso-pharnyx,  auditory  canal,  retina,  rectum,  and  other  ori- 
fices of  the  body  very  often  give  information  not  to  be  secured  in 
any  other  way.  The  various  methods  of  laboratory  diagnosis  are 
indispensable. 

The  ordinary  medical  physician  requires  only  a  diagnosis  of  the 
name  of  the  disease  from  which  the  patient  suffers,  and  his  medi- 
cines are  administered  accordingly.  But  the  osteopathic  practician 
must  know  the  entire  condition  of  the  patient,  and  this  means  that 
osteopathic  diagnosis  is  necessarily  more  thorough,  more  accurate 
and  much  more  important  in  determining  treatment  than  is  medical 
diagnosis. 

These  methods  modified  and  aided  by  pressure  and  rotation  of 
parts  either  singly  or  collectively  yield  sufficient  data  to  indicate 
the  essential  nature  of  most  of  the  disordered  conditions  which  the 
physician  meets.  All  of  them  have  their  uses  and  their  special  value 
and  the  osteopath  who  entirely  neglects  any  will  certainly  find 
occasion  to  regret  his  inability  to  make  satisfactory  use  of  that 
method. 

It  is  inappropriate  to  further  discuss  the  question  of  symptoms 
in  tli«  diagnosis  of  special  diseases.  It  is  necessary  at  this  time 
to  take  up  for  discussion  the  diagnosis  of  lesions.  A  consideration 
of  this  question  is  distinctly  and  peculiarly  osteopathic  since  it  is 
only  the  osteopath  who  has  recognized  the  existence  of  the  lesion, 
at  least  in  the  special  use  of  that  term  which  has  be6n  indicated 
in   another   chapter. 


CHAPTER  XXV 

THE  DIAGNOSIS  OF  LESIONS 

The  special  and  limited  meaning  of  lesion  is  an  osteopathic 
creation  and  hence  it  will  be  necessary  to  go  quite  into  detail  in 
the  discussion  of  the  factors  entering  into  the  determination  of 
the  presence  of  a  lesion  in  any  specific  case.  The  fact  has  been 
emphasized  that  not  every  malposition  of  bony  or  other  structures 
constitutes  a  lesion.  In  a  few  cases  such  a  condition  may  be  the 
only  evidence  of  lesion  and  still  be  a  real  lesion  in  the  two-fold  idea 
assigned  to  that  word,  structural  change,  producing  functional  dis- 
order, but  in  the  majority  of  cases  with  which  the  osteopath  deals 
there  will  be  other  evidences  which  substantiate  the  diagnosis.  Fur- 
ther, in  this  discussion  it  is  not  advisable  to  take  up  in  detail  the 
different  forms  of  lesion  as  they  may  exist  separately — bony,  muscu- 
lar, ligamentous,  visceral — but  the  consideration  will  be  limited  to 
a  typical  case  where  there  is  a  combination  of  the  first  three  named. 
For  it  cannot  be  too  strongly  emphasized  that  in  most  conditions 
of  skeletal  disorder  the  three  will  be  associated  in  the  causation  of 
the  functional  perversion.  In  this  discussion  the  presence  of  such 
an  association  is  assumed,  and  the  points  essential  in  the  diagnosis 
of  that  condition  will  be  indicated. 

Examination 

There  are  two  fundamental  methods  of  procedure  to  be  noted 
in  making  an  examination  of  any  part  of  the  body,  the  one  of  which 
will  tend  to  prevent  possible  error  arising  from  the  other.  The  part 
should  be  examined  in  its  (1)  functional  activity.  A  perverted 
function  is  manifest  in  the  appearance  of  the  action  of  the  organ 
which  performs  the  function.  In  torticollis  or  wryneck  the  sterno- 
mastoid  muscle  presents  an  appearance  when  in  action  entirely 
different  from  that  while  at  rest.  Comparison  of  the  muscle  in  the 
horizontal  position  with  it  in  the  erect  position  of  the  body  suggests 
facts  that  otherwise  escape  attention.  In  the  horizontal  position  the 
neck  muscles  are  in  (2)  functional  rest.     In  the  examination  of  a 

115 


116  PRINCIPLES  OF  OSTEOPATHY 

hip  the  action  of  it  should  be  noted,  but  in  addition  the  position  of 
its  various  parts  should  be  determined  by  palpation  during  its 
rest.  The  movement  of  the  chest  should  be  noted  and  compared 
with  that  of  a  normal  action,  but  in  addition  there  should  be  noted 
the  position  of  the  ribs  while  in  expiration  and  pause.  The  move- 
ment of  the  inferior  maxillary  may  suggest  the  nature  of  the  lesion 
less  noticeably  than  an  examination  of  it  in  the  quiet  state. 

Perversion  of  Function 

Passing  to  the  details  in  diagnosis  it  will  be  noted  that  the  first 
evidence  that  a  lesion  exists  is  the  perversion  of  function  of  some 
organ  or  structure,  which  is  likely  to  be  first  discerned  by  the  pa- 
tient or  some  one  other  than  the  physician.  The  patient  gives  the 
information  that  he  has  functional  disorder  of  some  special 
organ.  That  fact  indicates  in  general  the  part  of  the  or- 
ganism where  lesion  is  most  likely  to  be  found;  if  it  be  gastric  dis- 
turbance the  splanchnic  or  the  vagal  region  will  be  suspected;  if  a 
uterine  trouble,  the  lower  thoracic,  the  lumbar,  or  sacral  structures 
are  first  examined;  if  the  eye  be  impaired,  the  atlas  and  the  upper 
thoracic  are  more  likely  disturbed. 


Attitude 

The  general  attitude  is  a  factor  in  the  determination  of  the 
approximate  location  of  the  lesion.  Dr.  Still  has  emphasized  the 
fact  that  the  position  that  a  patient  assumes  is  normal  to  the  exist- 
ing structural  condition,  which  is  but  a  special  application  of  the 
doctrine  that  function  is  normal  to  structure.  To  make  a  concrete 
case,  suppose  a  lesion  of  considerable  magnitude  exists  in  the  cer- 
vical muscles  of  the  patient.  The  manner  in  which  he  carries  the 
head  suggests  a  cervical  lesion.  If  a  rib  be  subluxated  the  patient 
sits  in  such  a  position  as  to  secure  to  him  the  least  irritation.  The 
careful  way  in  which  an  individual  afflicted  with  Pott's  disease 
carries  his  body  immediately  suggests  a  spinal  lesion.  In  all  of 
these  cases  the  position  or  the  attitude  is  the  result  of  the  lesion; 
that  is,  the  lesion  or  its  effects  compel  it  to  be  such.  Hence  the 
value,  when  a  patient  presents  himself  for  examination,  of  making 
a  preliminary  survey  of  the  individual  as  a  whole. 


THE  DIAGNOSIS  OF   LESIONS  117 

Landmarks . 

The  position  of  landmarks  is  a  third  point  to  be  considered. 
Having  determined  the  probable  region  of  the  lesion  by  the  method 
above  described,  a  peculiarity  in  the  positional  relation  between 
certain  parts  used  as  points  for  comparison  may  be  noticed.  In  the 
case  of  a  vertebra,  the  relation  of  its  spinous  process  to  those 
adjacent  may  be  altered ;  the  intercostal  space,  in  case  of  a  rib,  may 
be  found  to  vary  in  regularity  throughout  its  extent,  or  may  be 
narrowed  or  widened  in  comparison  with  those  above  or  below; 
the  lower  margin  of  the  liver,  in  malposition  or  enlargement  of  that 
organ,  is  displaced.  It  seems  necessary  to  emphasize  the  fact  in 
this  connection,  that  no  greater  mistake  can  be  or  has  been  made 
than  that  of  assuming  the  existence  of  a  lesion  whenever  it  is  found 
that  there  is  a  variation  in  position  of  a  structure.  Reference  has 
been  made  to  the  fact  that  structure  as  well  as  function  can  vary 
from  the  average  within  wide  limits  and  still  the  condition  be  a 
normal  one.  While  it  is  convenient  to  compare  the  body  to  a  ma- 
chine and  insist  that  in  both  cases  a  variation  of  the  slightest  degree 
in  structural  parts  will  cause  disorder  in  the  one  as  in  the  other, 
the  comparison  is  not  illuminating  if  carried  to  extremes.  The 
machine  is  an  unyielding  structure  and  has  no  power  of  adjustment, 
which  makes  the  necessity  for  perfect  structural  alignment  an 
absolute  one.  The  living  machine,  on  the  other  hand,  is  made  up  of 
yielding  parts  and  has  marked  possibilities  of  adjustment  to  struc- 
tural changes.  The  universal  tendency  on  the  part  of  the  beginning 
student  seems  to  be  to  make  the  assumption — unfortunate  as  that 
fact  may  be — that  every  unusual  situation  of  a  bony  land-mark  is 
abnormal.  In  some  cases  it  would  seem  that  the  apparent  structural 
change  is,  of  all  the  several  evidences  of  lesion,  the  most  unreliable. 

Sensory  Perversions 

A  further  evidence  of  the  presence  of  the  lesion  is  the  sensory 
change.  While  this  usually  takes  the  form  of  a  definite  pain,  in 
many  cases  it  is  of  the  nature  of  such  sensations  as  anaesthesia, 
hyperajsthesia,  or  paresthesia;  under  the  latter  term  is  included 
the  burning  sensations,  tightness  of  tissue,  or  of  formication,  i.  e., 
sensation  as  of  a  small  insect  creeping  over  a  part.    Any  of  these 


118  PRINCIPLES  OF  OSTEOPATHY 

may  be  present  either  at  the  local  area  of  the  lesion  or  may  be 
remotely  situated  and  partake  of  the  nature  of  referred  sensation. 

Pain  is  of  such  importance  that  it  is  necessary  to  enter  into 
detail  showing  its  relation  to  lesion  and  disease.  It  is  a  sensation, 
perceived  by  the  cerebral  cells  concerned  with  consciousness,  pro- 
duced by  irritation  of  the  sensory  nerve.  There  are  specialized  nerve 
endings,  nerve  fibers,  and  nerve  pathways  in  the  cord  for  sensations 
of  pain ;  while  it  appears  also  that  any  afferent  nerve  sufficiently  irri- 
tated gives  the  sensation  of  pain.  Note  the  fact  that  the  sensation  is 
a  brain  function  though  it  is  usually  projected  to  the  part  irritated. 
Fcr  instance,  the  sensation  from  a  burned  finger  is  felt  in  the  sen- 
sorium  but  the  individual  is  entirely  aware  that  the  irritation  is  at 
the  finger.  With  reference  to  this  fact,  note  the  want  of  logic 
in  the  reasoning  of  the  individual  who  is  content  with  giving  a 
drug  which  renders  the  sensorium  less  capable  of  receiving  or  re- 
sponding to  the  transmitted  impulse.  The  pain  is  still  present 
in  so  far  as  the  nerve  disturbance  constitutes  the  pain.  The  drug 
has  simply  rendered  the  patient  unaware  of  the  existence  of  irri- 
tation. Pain,  then,  is  a  distinct  advantage  to  the  organism,  and  it  is 
in  relation  to  its  advantage  in  the  way  of  assistance  in  the  diagnosis 
of  the  lesion  that  it  will  further  be  discussed. 


CHAPTER  XXVI 

PAIN  IN  LESIONED  AREAS 

It  is  to  be  noted  that  pain  may  be  direct  as  when  caused  by- 
irritation  produced  directly  upon  the  part  to  which  the  sensation 
is  projected.  For  instance,  an  irritant  taken  into  the  stomach  may 
cause  the  sensation  noticed  in  that  region  j  or  pressure  upon  the 
ulnar  nerve  cause  pain  at  the  point  of  pressure ;  a  contracted  mus- 
cle—e.  g.,  the  pyriformis,  may  irritate  directly  the  sciatic  nerve 
and  the  whole  nerve  suffer.  In  this  case  the  pain  is  felt  not  only 
at  the  point  of  pressure  but  throughout  the  entire  nerve  trunk;  for 
note  that  in  the  pressure  on  the  ulnar,  while  the  pain  may  be  at  the 
point  of  pressure,  it  is  likely  more  noticed  in  the  finger,  i.  e.,  at  the 
peripheral  end  organs.  In  this  case  it  is  not  necessarily  simply  a 
reference  by  consciousness,  but  an  actual  disturbance  of  molecular 
vibration  throughout  the  entire  nerve  element,  and  the  greatest 
intensity  of  impulse  will  seem  to  come  from  those  parts  which  are 
especially  developed  for  the  purpose,  as  the  sensory  endings  in  the 
periphery. 

Referred  Pain 

The  pain  may  be  indirect  or  referred.  In  this  case  a  peculiar 
fact  is  to  be  noted,  a  fact  that  has  been  put  in  definite  formu- 
lation by  Head  and  which  is  spoken  of  as  Head's  Law.  This 
law  states  that,  "When  a  painful  stimulus  is  applied  to  a  part  of 
low  sensibility  in  close  central  connection  with  a  part  of  much 
greater  sensibility,  the  pain  produced  is  felt  in  the  part  of  higher 
sensibility  rather  than  in  the  part  of  lower  sensibility  to  which 
the  stimulus  was  actually  applied."  "While  this  is  a  fairly  correct 
statement  of  the  real  condition  it  should  not  be  dignified  by  the 
name  of  law,  since  in  the  above  wording  it  cannot  apply  to  all 
cases  by  any  means.  Head  based  the  law  on  observations  with 
especial  reference  to  visceral  versus  spinal  pain.  It  is  known  that 
many  of  the  viscera  are  comparatively  insentient  under  ordinary 
conditions.  That  is,  the  nerves  capable  of  conducting  an  impulse 
producing  the  sensation  of  pain  are  comparatively  few  and  ineffi- 
cient, and  hence  the  irritation  sufficient  to  give  pain  must  be  cor- 
respondingly intense.  But  every  one  is  aware  that  pain  may  be 
produced  in  a  viscus  and  definitely  projected  to  that  viscus,  and  in 

119 


120  PRINCIPLES  OF  OSTEOPATHY 

order  to  show  that  Head's  Law  holds,  it  must  be  proved  that  the 
part  of  higher  sensibility  is  the  part  most  noticed  by  consciousness 
on  the  application  of  the  stimulus  to  the  more  insentient  organ. 
That  such  is  the  case  in  numerous  instances  may  readily  be  admitted 
but  that  it  is  true  in  all  is  disproved.  Were  it  stated  that  the  pain 
may  be  felt  in  the  part  of  higher  sensibility  the  objection  to  the 
statement  would  cease.  In  this  latter  interpretation  the  question 
will  be  considered.  Note  that  the  law  provides  for  a  condition 
where  there  is  a  "close  central  connection." 

Anatomical  Relations 

Though  little  evidence  of  an  anatomical  nature  can  be  adduced, 
there  is  much  from  physiological  and  embryological  investigation 
to  show  that  the  spinal  cord  and  less  noticeably  the  brain  are  seg- 
mental structures.  The  cord  may  be  arbitrarily  divided  into  seg- 
ments corresponding  to  the  paired  arrangement  of  the  spinal  nerves, 
and  we  may  assume  with  little  probability  of  error  that  this  divis- 
ion represents  a  physiological  segmentation.  That  each  part  of  a 
segment  acts  more  with  reference  to  its  other  parts  than  to  parts 
from  an  adjacent  segment,  is  a  statement  that  is  true  in  general. 
Hence,  two  nerve  fibers  having  their  central  endings  in  the  same 
segment  will  be  in  more  intimate  relation  than  fibers  from  different 
segments.  This  fact  is  indicated  from  various  evidences  derived 
from  experiment,  especially  in  reference  to  reflax  action.  For  in- 
stance, Pfluger  has  shown  that  a  stimulus  applied  to  a  limb  of  a 
"spinal  frog"  produces  its  first  response  in  motion  of  that  limb,  but 
the  next  effect,  produced  by  a  stronger  stimulus,  is  upon  the  limb  of 
the  opposite  side,  showing  the  radiation  of  the  impulse  to  parts 
in  the  same  segment.  An  additional  stimulus  causes  effect  on  nerves 
from  the  immediately  adjacent  segments.  But  according  to  Plead 
and  others  who  have  investigated  the  same  problem,  the  phenomenon 
is  not  limited  to  a  reflex  mechanism  such  as  is  present  in  the  above 
eases.  A  sensory  nerve  in  connection  with  the  same  segment  may 
be  involved,  or  at  least  the  pain  may  be  referred  to  the  area  of 
distribution  of  that  sensory  nerve.  Head  calls  attention  to  the  fact 
that  with  a  few  possible  exceptions,  each  viscus  is  related  in  this 
way  to  a  definite  area  of  cutaneous  tissue.  For  instance,  irritation 
of  the  stomach  is  likely  to  be  associated  with  pain  in  the  skin  areas 
supplied  l)y  afferent  fibers  from  the  sixth,  seventh,  eighth  and  ninth 


PAIN  IN  LESIONED  AREAS  121 

thoracic  nerves.  It  is  significant  that  the  pain  is  not  necessarily 
of  a  simple  "referred"  or  "transferred"  character.  It  is  noted 
that  in  numerous  cases  there  will  not  only  be  referred  pain,  but  what 
is  a  different  thing,  so  called  referred  tenderness,  in  which  case 
it  is  suggestive  of  distinct  nerve  disturbance  rather  than  a  reference 
on  the  part  of  consciousness. 

The  reference  of  pain  is  not  necessarily  from  a  diseased  viscus. 
Osteopaths  continually  have  this  fact  called  to  their  attention  by 
numerous  cases.  Hip  trouble  gives  rise  to  pain  in  the  knee.  This 
may  be  due  to  direct  pressure  by  the  luxated  structures  or  localized 
edema  upon  the  nerve  supplying  the  articulation,  or  it  may  be  due 
to  impingement  upon  the  terminals  of  branches  distributed  to  the 
hip-joint  referred  back  to  the  segment,  and  thence  out  over  the 
branch  to  the  knee.  For  we  know  that  the  same  trunks  which 
supply  the  articular  structures  of  the  hip  also  supply  those  of  the 
knee.  Similarly  Hilton^  calls  attention  to  the  fact  that  the  same 
nerve  trunk  that  supplies  a  joint,  also  supplies  the  skin  which  over- 
lies it  and  the  muscles  that  move  it,  and  a  further  usual  circumstance 
of  interest,  that  the  bowel  wall,  the  peritoneal  structures  associated 
with  it,  and  the  skin  overlying  these,  are  supplied  from  the  same 
segmental  source.  Earache  may  be  associated  with  disturbances 
in  the  nutrition  of  the  teeth,  both  of  these  structures  being  supplied 
by  the  fifth  cranial. 

Central  Origin  of  Pain 

In  all  of  these  cases  there  is  a  principle  that  is  similar  if  not  iden- 
tical— it  is  a  physiological  principle  operative  in  a  distinctly  bene- 
ficent way  under  ordinary  circumstances.  Parts  thus  intimately 
associated  anatomically  are  made  to  act  in  harmony  not  only  in 
normal  but  in  abnormal  conditions.  Further  facts  suggested  by 
Hilton  in  relation  to  referred  pain  may  be  of  some  value.  He  notes 
first  that  pain  in  the  superficial  structures  not  associated  with  a  high 
temperature  of  the  part  is  suggestive  of  a  distinct  origin  of  the 
pain,  and  usually  that  origin  is  in  the  spine.  He  instances  in  this 
connection  what  osteopaths  have  been  able  to  corroborate  in  many 
cases,  that  a  sensory  disturbance  in  the  anterior  terminals  of  the 
thoracic  spinal  nerves  is  often  due  to  a  spinal  lesion,  no  local  dis- 


^Hilton:     Rest  and  Pain. 


122  PRINCIPLES  OF  OSTEOPATHY 

order  being  manifest.  A  further  rule  is  that  when  the  pain  is  sym- 
metrical it  is  almost  certainly  caused  by  a  central  disorder.  The 
application  of  the  foregoing  facts  is  apparent.  By  means  of  the 
pain  or  tenderness  we  may  trace  the  situation  of  the  segment  of  the 
cord  which  is  involved.  That  involvement  may  be  or  may  not  be 
dependent  on  a  lesion  at  the  corresponding  vertebra,  but  in  the 
majority  of  cases  such  a  lesion,  is  found.  Even  though  the  definite 
structural  change  be  absent  from  this  part,  the  organ  involved  is 
indicated  and  indirect  aid  is  given  in  the  diagnosis. 

Hypersensitive  Areas 

The  tender  spots,  for  the  discovery  of  which  the  osteopath  is 
famous,  are  always  significant.  In  most  cases  these  points  of  in- 
creased sensitiveness  are  quite  limited  in  extent  and  suggest  not 
a  referred  but  a  direct  irritation.  For  instance,  in  the  examination 
of  a  lesion  of  the  spine  the  tissues  at  the  region  between  the  spinous 
and  transverse  processes  are  tender  on  pressure.  This  is  always 
suggestive  of  local  disturbance,  congestion,  inflammation,  or  edema 
01  tissues  sufficient  to  irritate  the  sensory  nerve  terminals  in  the 
part.  In  palpation  for  such  tender  areas  care  must  always  be 
exercised  or  a  tender  spot  may  be  produced  where  none  before 
existed.  Bear  in  mind  that  sufficient  pressure  in  any  part,  whether 
normal  or  abnormal,  produces  pain  or  'some  other  sensory  change. 
The  sensory  condition  of  the  part  under  examination  must  always 
be  compared  with  similar  adjacent  areas  and  with  the  average  con- 
dition. This  last  may  be  a  question  of  experience — the  average 
normal  condition  must  be  learned  before  there  can  be  much  possi- 
bility of  detecting  slight  changes — a  statement  true  not  only  with 
reference  to  pain  but  to  all  the  several  factors  enumerated. 


CHAPTER  XXVn 
MUSCULAR  CHANGES  IN  LESIONED  AREAS 

Another  valuable  factor  in  determination  of  the  presence  of  a 
lesion  is  the  condition  of  the  associated  muscle  tissue.  This  is 
usually  spoken  of  as  a  contracture,  the  causes  of  which  have  been 
referred  to  in  the  section  on  causes  of  lesions.  It  becomes  necessary 
to  distinguish  between  the  meaning  of  contraction  and  contracture 
in  order  that  confusion  may  not  arise.  The  term  contraction  refers 
to  the  state  of  a  muscle  in  the  physiological  process  or  condition 
of  shortening  and  thickening. 

"Voluntary  muscular  contractions  are  actually  tetanic,  that  is, 
even  our  briefest  muscular  movements  are  the  result  of  a  series 
of  stimuli  sent  into  the  muscle  at  regular  intervals  during  the 
continuance  of  its  contraction  ...  It  must  be  evident,  there- 
fore, that  the  motor  cells  innervating  a  muscle  always  discharge  a 
series  of  impulses  which  give  rise  to  a  serial  evolution  of  muscular 
energy  .  .  ,  These  statements  may  also  be  applied  to  the  tonus 
of  a  muscle,  with  this  modification,  however,  that  the  stimuli  upon 
which  the  tonic  condition  of  muscle  depends  are  of  subminimal  in- 
tensity .  .  .  The  term  contracture  signifies  that  thn  relaxation 
of  the  previously  contracted  muscle  is  unduly  prolonged,  or,  as 
may  also  be  said,  that  its  contraction  is  maintained  for  an  abnor- 
mally long  time.  This  condition  is  frequently  encountered  during 
fatigue,  or  when  a  fresh  muscle  is  cooled,  or  is  subjected  to  exces- 
sive stimulation."^  Such  muscles  may  be  found  in  hemiplegia, 
hysteria,  under  the  influence  of  veratrin  or  certain  other  drugs, 
and  in  the  neighborhood  of  vertebral  lesions.^  Unless  degenerated, 
such  muscles  react  to  stimuli  by  diminished,  though  otherwise 
normal,  contractions  or  tetani. 

The  term  contracture  is  also  used  by  certain  authors  in  a  differ- 
ent sense :  a  muscle  subjected  to  chronic  inflammation  undergoes 
increase  of  connective  tissue,  becomes  shortened,  and  the  muscle 
undergoes  atrophy.    In  lower  neuron  paralysis,  the  muscles  undergo 


iBurton-Orpitz:      Physiology,   1920. 
2Bulletiii  No.  4:     The  A.  T.  Still  Eesearch  Institute. 

123 


124  PRINCIPLES  OF  OSTEOPATHY 

atrophy,  and  the  muscles  become  shortened  and  infiltrated  with 
connective  tissues.  Muscles  under  both  conditions  are  said  to  be 
contractured. 

The  term  rigor  is  also  applied  to  muscles  affected  by  vertebral 
lesions.  Such  muscles  are  swollen,  subalkaline,  edematous,  con- 
gested, hypersensitive,  more  extensible  than  normal,  and  give  dimin- 
ished response  to  stimuli.  The  muscle  gives  a  sensation  of  irregu- 
larity to  the  examining  fingers;  the  muscle  seems  ropy,  and  welted 
and  lumpy,  while  between  these  hardened  areas  there  is  a  peculiar 
dense  quality;  due,  no  doubt,  to  the  edema.  On  microscopic  exami- 
nation, such  muscles  show  edema,  cloudy  swelling  of  the  muscle  cells, 
dilatation  of  the  capillaries,  with  some  hemorrhages  per  diapedsin. 
Similar  conditions  are  found  in  rigor  mortis  during  the  early  stages, 
during  rigor  caloris,  and  water-rigor,  as  well  as  in  rigor  due  to 
the  action  of  certain  chemical  substances. 

Such  muscles  are  hypersensitive  in  experimental  animals,  as  well 
as  in  human  beings  suffering  from  bony  lesions.  Emphasis  should 
be  laid  upon  the  fact  that  a  persistent  contraction  or  contracture 
invariably  results  in  a  sensory  disorder  of  some  kind.  Finally, 
material  aid  may  be  given  in  the  determination  between  a  muscle 
physiologically  contracted  and  one  in  contracture  by  causing  the 
lodividual  or  part  to  assume  a  position  in  which  the  necessity  for 
physiological  contraction  ceases  to  exist.  For  instance,  so  long  as 
the  individual  is  in  the  sitting  posture  the  deep  cervical  muscles 
are  functionally  active.  On  assuming  the  horizontal  position  the 
necessity  for  their  contraction  ceases  to  exist  and  they  normally 
relax.  If,  however,  the  muscles  be  contractured  or  in  rigor,  the 
relaxation  on  changing  position  will  not  be  so  apparent.  Note  that 
h  is  s  condition  of  degree,  for  the  abnormal  muscle  undergoes 
partial  relaxation  when  its  contraction  is  no  longer  needed. 

Amplitude 

The  amplitude  of  movement  is  a  factor  of  much  value  in  diag- 
nosis of  the  lesion  and  one  which  is  closely  associated  with  the 
condition  of  all  structures.  It  was  noted  that  in  typical  lesions 
bony,  ligamentoiis,  and  muscular  changes  are  associated  and  inter- 
dependent. All  three  are  concerned  in  producing  the  change  in  the 
rie(>floni  with  wliich  the  part  moves.    A  bony  luxation  usually  lessens 


MUSCULAR  CHANGES  IN   LESIONED  AREAS  125 

the  extent  of  movement  and  so  do  ligamentous  strain  and  muscle 
contracture.  On  the  other  hand  a  lax  ligamentous  and  muscular 
condition  permits  excessive  rotation.  The  condition  of  the  spine 
spoken  of  as  a  rigid  spinal  column  is  a  case  in  point.  The  rigidity 
may  be  due  to  "locked"  vertebrae — rare — thickened  and  hardened 
connective  structures,  deposits  in  or  absorption  of  intervertebral 
and  articular  cartilages  as  in  articular  rheumatism,  or  to  simple 
but  general  functional  muscle  contracture,  in  the  latter  case  usually 
yielding  on  application  of  measures  designed  to  relax  the  muscles. 
Bony  ankylosis  is  a  condition  occasionally  met  with  and  will  man- 
ifest itself  by  absolute  mobility.  The  X-ray  is  of  great  service  in 
distinguishing  between  these  conditions. 

Temperature  Changes 

Temperature  change  in  the  local  part  is  often  found  and  usually 
is  indicative  of  local  lesion.  The  existence  of  a  lesion  means  local 
irritation.  Irritation  results  in  hyperaemia  and  hypersemia  may 
pass  into  inflammation.  In  either  of  the  last  two  conditions  there 
is  increased  heat  because  of  increased  blood,  the  latter  being  the 
principal  medium  by  which  heat  is  distributed. 

The  increased  temperature  may  be  locally  produced.  Especially 
is  this  likely  where  local  inflammation  is  present,  the  increased  met- 
abolic changes  being  responsible  for  an  increased  oxidation  with 
liberation  of  heat.  Attention  is  occasionally  called  to  a  rib  lesion 
through  the  difference  in  temperature  along  the  course  of  the  rib 
as  compared  to  that  above  or  below.  It  is  not  necessarily  an  in- 
crease but  may  be  a  decrease  in  temperature  that  is  noticed.  A 
cold  state  of  the  posterior  cervical  structures  is  a  common  accom- 
paniment of  lesion  in  that  region.  Dr.  Still  calls  attention  to  the 
fact  that  there  is  a  lowered  temperature  of  the  skiij  in  the  gluteal 
and  lower  spinal  regions  in  case  of  croup,  while  the  ventral  struc- 
tures may  show  an  increased  temperature.  The  numerous  cases 
noted  and  the  equally  numerous  possible  causes  of  changed  temper- 
ature suggest  the  importance  of  a  careful  training  of  the  fingers 
in  the  temperature  sense. 

Finally,  the  color  of  the  part  under  suspicion  may  be  an  indi- 
cation of  a  lesion.  In  most  cases  the  difference  in  color  is  dependent 
on  the  amount  of  blood  present,  congestion  causing  redness,  isch- 


126  PRINCIPLES  OF  OSTEOPATHY 

aBinia  producing  pallor.  Pigmentary  deposits  may  occasionally  be 
noted  in  the  region  of  a  lesion,  from  the  blood  or  other  change 
associated. 

In  all  the  examination  for  the  nature  and  location  of  a  lesion 
the  several  factors  mentioned  should  be  borne  in  mind.  In  the  vast 
majority  of  cases  only  a  few  of  them  are  appreciably  present.  The 
greater  the  number  the  more  certain  the  diagnosis.  The  absence 
of  one  or  all  does  not  disprove  the  presence  of  a  real  lesion  and  a 
serious  one  but  renders  its  presence  less  easily  recognizable.  Note 
the  fact  that  numerous  osteopaths  are  quoted  in  the  expression, 
''There  was  no  lesion  in  the  case."  The  want  of  logic  evidenced 
by  such  assertion  is  quite  apparent.  To  assume  that  every  lesion 
can  be  detected  is  to  assume  the  impossible.  Lesions  may  be  micro- 
scopic and  still  be  lesions  as  judged  by  our  definition,  and  he  who 
thinks  it  necessary,  in  the  case  of  imperceptible  lesion,  to  assume 
the  existence  of  some  other  cause  for  the  disorder  than  that  of  the 
lesion,  or  that  the  manipulation  of  a  part  which  produced  a  cure 
of  the  disorder  did  so  otherwise  than  by  removal  of  lesion,  is  making 
use  of  extremely  faulty  logic. 


CHAPTER  XXVIII 

THE  TREATMENT   OF  DISEASE 

Prophylaxis  and  Therapeutics 

The  ultimate  end  which  is  kept  in  view  in  the  determination 
of  the  etiology  and  diagnosis  of  disease  is  to  establish  a  rational 
basis  for  the  treatment  of  disease.  By  the  treatment  of  disease 
is  meant  any  method  or  measure  which  will  assist  the  organism  in 
re-establishing  its  normal  function.  More  appropriately,  it  is  the 
treatment  of  the  diseased  organism  rather  than  the  treatment  of 
disease,  for  the  disease  will  be  disposed  of  by  the  organism  itself 
if  freedom  is  given  to  the  healing  agencies  inherent  in  the  organism. 
Broadly  speaking,  there  are  two  grand  divisions  comprehended  in 
the  word  treatment,  one  of  which  is  concerned  with  all  those  meas- 
ures designed  to  prevent  the  onset  of  disturbed  functioning.  Tech- 
nically this  is  spoken  of  as  prophylaxis. 

The  term  prophylaxis  is  a  comprehensive  one  and  has  rather  in- 
definite limits.  In  the  first  place  it  is  concerned  with  the  conditions 
of  the  environment  of  the  individual.  Sanitary  measures  employed 
by  a  municipality,  including  regulations  governing  sewerage  sys- 
tems, tenement  house  requirements  and  the  like,  constitute  definite 
prophylactic  treatment  applied  collectively.  Hygiene  in  the  nature 
of  cleanliness,  normal  exercise,  and  the  breathing  of  pure  air  or  the 
eating  of  proper  food  in  proper  amounts,  constitutes  prophylaxis 
of  the  individual  in  connection  with  his  environment.  On  the  other 
hand  prophylaxis  is  applied  directly  to  the  organism  itself  either 
by  the  removal  of  the  predisposing  cause,  as  for  instance  the  increas- 
ing of  the  chest  capacity  by  lifting  and  adjusting  the  ribs  in  order 
to  avoid  furnishing  suitable  soil  for  the  propagation  of  the  tubercle 
bacillus ;  overcoming  the  irritability  of  the  mucous  membrane  of  the 
nasal  passages  to  prevent  an  attack  of  hay  fever  brought  on  by  the 
presence  of  dust  particles  in  the  air;  or  insistence  on  abstaining 
from  further  abuse  of  an  organ  which  otherwise  would  ultimately 

127 


128  PRINCIPLES  OF  OSTEOPATHY 

result  in  exhaustion  and  henee  disease,  for  example,  where  there 
is  a  tendency  to  writer's  cramp;  or  prophylaxis  is  applied  in  the 
avoidance  of  the  exciting  cause,  or  the  direct  destruction  of  that 
exciting  cause.  As  illustration  of  the  latter,  the  patient  may  be 
directed  to  move  to  a  climate  more  favorable  to  his  health,  as  in 
the  hay  fever  victim  who  passes  his  summers  in  an  atmosphere  less 
laden  with  irritating*  particles ;  or  the  use  of  antiseptic  washes  in 
the  case  of  contagious  diseases. 

Measures  may  be  applied  in  the  treatment  of  the  organism  after 
the  disease  is  present  and  this  constitutes  what  is  technically  spoken 
of  as  therapeutics.  It  is  necessary  to  observe  as  a  precaution  that 
many  writers  make  use  of  this  term  to  embrace  both  preventive 
and  curative  treatment.  As  a  matter  of  convenience  the  two  terms 
sliould  be  kept  within  their  proper  limitations.  In  the  application 
of  therapeutic  treatment  one  or  both  of  two  policies  may  be  pur- 
sued, the  removal  of  the  lesion  condition  or  the  abstinence  from  any 
use  of  the  organ  that  under  the  circumstances  would  constitute  an 
abuse.  In  the  case  of  an  individual  afflicted  with  stomach  trouble 
dependent  upon  a  splanchnic  lesion  the  proper  treatment  for  such 
disorder  would  consist  in  the  removal  of  the  specific  lesion.  So 
long  as  the  lesion  exists  some  care  may  be  necessary  to  avoid  any 
overwork  or  other  abuse  of  that  organ.  If  on  the  other  hand  the 
primary  cause  of  the  gastric  unrest  is  abuse  by  errors  in  diet, 
therapeutics  would  consist — granting  there  was  no  lesion  present — 
ill  the  regulation  of  the  dietetic  habits  of  the  patient. 

Of  the  two  ideas  associated  with  treatment,  that  of  prophylaxis 
occupies  the  higher  plane,  for  prevention  is  always  better  than  cure 
though  not  necessarily  in  the  ratio  of  the  ounce  to  the  pound.  It 
is  the  dream  of  the  idealist  that  a  time  may  come  when  there  will 
be  a  greater  demand  on  the  part  of  the  people  for  prophylactic  than 
for  therapeutic  treatment;  when  the  individual  will  pay  greater 
attention  to  laws  of  health  and  will  go  at  frequent  intervals  to  a 
qualified  physician  for  the  purpose  of  physical  examination  to  detect 
any  predisposing  lesions  that  may  have  arisen  since  the  last  exam- 
ination or  treatment.  But  the  dream  of  the  idealist  will  hardly 
be   realized  in  this   generation.     The  average   osteopath  is  called 


THE   TREATMENT   OF   DISEASE  129 

upon  to  treat  a  case  only  after  the  evidence  of  disorder  is  markedly 
present.  Hence  relatively  greater  stress  must  at  present  be  laid 
upon  the  therapeutic  side,  except  that  the  physician  may  make  him- 
self a  distinct  force  for  the  dissemination  of  knowledge  regarding 
the  body  and  the  laws  of  its  health,  together  with  a  hearty  eo-opera- 
Lion  with  all  legitimate  efforts  to  enforce  sanitary  measures  ap- 
plied collectively  to  a  city  or  community. 

Lesion  in  Prophylaxis 

The  relation  that  the  removal  of  lesion  bears  to  prophylaxis, 
even  in  case  of  a  therapeutic  treatment,  the  author  has  discussed 
in  a  former  article,  a  part  of  which  is  reproduced  in  this  con- 
nection: "But  after  all  that  may  be  said  of  the  curative  treatment, 
is  not  every  osteopathic  treatment  a  prophylactic  one?  The  use 
of  the  term  curative  is  essentially  incorrect.  The  physician  does 
not  cure.  We  object  to  the  definition  of  osteopathy  which  affirms 
that  the  physician  'directs'  the  inherent  recuperative  forces  of  the 
body.  The  direction  of  those  forces  abides  in  a  higher  and  more 
subtle  power  than  can  be  exercised  by  the  hand  of  another  indi- 
vidual even  though  it  may  be  guided  by  a  high  order  of  intelligence. 
Neither  does  he  'regulate  functioning,'  except  in  a  secondary  sense. 

*  *  Functions  are  controlled  by  an  inherent  force  which  we 
denominate  vital.  That  force  itself  cannot  go  permanently  wrong. 
It  will  not  cause  permanent  disorder  of  structure  except  it  be 
hindered  by  blocked  channels  of  interchange.  And  herein  lies 
Llie  fallacy  of  the  Christian  Scientist  and  all  other  mental  healers. 
The  'tendency  to  the  normal'  operates  in  psychic  as  well  as  in 
material  substance,  and  the  normal  in  mind  and  emotion  will  be 
assumed  if  the  organization  of  cell  life  be  intact.  If  then  the 
physician  does  not  regulate  functions  or  direct  forces,  what  does 
he  do?  Fundamentally,  he  clears  the  way.  Does  that  cure?  The 
disease  as  it  existed  before  the  lesion  was  removed  was  caused 
by  perverted  function  resulting  from  the  lesion.  On  the  removal 
of  the  lesion  the  disease  as  it  exists  is  overcome  by  the  restored 
normal  functioning.  The  physician  in  removing  the  lesion  has  pre- 
vented the  further  progress  of  the  disease.  He  has  applied  pre- 
ventive treatment. 


130  PRINCIPLES  OF  OSTEOPATHY 

' '  Is  it  the  assertion  of  an  extremist  to  say  further  than  that  even 
m  the  removal  of  a  lesion  the  physician  is  not  overcoming  a  struc- 
tural condition?  In  the  vast  majority  of  cases  which  the  osteopath 
meets,  the  treatment  does  not  consist  in  setting  a  bone,  if  we  use 
that  term  in  the  sense  in  which  it  is  commonly  used.  In  a  case  of 
a  recently  luxated  hip  the  osteopath  may  be  successful  in  one  treat- 
ment. In  such  a  ease  he  perhaps  is  not  simply  aiding  nature.  But 
in  the  countless  other  lesions  met  with,  chronic  changes  are  present 
which  do  not  admit  of  immediate  replacement.  In  such  cases  the 
prime  importance  of  the  physician  is  as  an  assistant  to  the  organ- 
ism. Where  a  lesion  is  produced  by  wnatever  cause  one  of  several 
things  takes  place.  Nature  first  attempts  to  overcome  the  structural 
disturbance  and  is  usug,lly  successful.  Every  football  player  and 
every  one  who  has  watched  the  game  will  readily  believe  that 
numerous  structural  conditions  are  produced  during  the  strenuous 
periods.  Do  every  one  of  these  need  a  treatment  ?  Hardly.  Tension 
of  tissue  supplies  sufficient  treatment.  But  occasionally  a  structural 
disorder  is  sufficient  in  degree  to  pass  the  limits  of  self-adjustment. 
Failing  in  drawing  the  part  back  to  normal  the  tissues  on  one  side 
gradually  yield,  on  the  other  gradually  shorten,  and  with  other 
changes  a  partial  adjustment  to  the  new  circumstances  takes  place. 
What  must  the  osteopath  do?  In  the  case  where  nature  is  still 
making  the  attempt  to  re-align,  he  can  release  the  hindering  struc- 
tures and  in  the  average  case  'nature  will  do  the  rest.'  In  this 
case  he  is  not  curing;  he  is  preventing.  Where  complete  adjust- 
ment to  the  changed  condition  has  taken  place  he  is  perhaps  more 
surely  applying  a  curative  measure  in  the  breaking  up  of  adhesions 
and  stretching  permanently  shortened  muscles  and  ligaments."^ 

Corrective  Versus  Palliative  Treatment 

A  further  classification  of  treatment  is  made  having  reference 
to  the  immediate  purpose  and  effect,  as  to  whether  it  be  corrective 

'Journal  of  Osteopathy,  Nov.,  1902.     The  Ounce  of  Prevention. 


THE  TREATMENT  OF  DISEASE  131 

by  virtue  of  aiding  in  the  removal  of  the  cause  of  disease,  or  whether 
it  be  palliative,  in  which  case  it  is  directed  to  a  symptom  rather  than 
a  cause.  If  the  physician  overcomes  or  assists  the  organism  in  over- 
coming a  lesion  of  the  spine  which  is  causing  heart  disorder,  or  if 
the  patient  himself  abstains  from  the  abuse  of  his  heart  by  over 
exercise  where  such  has  been  the  cause,  a  corrective  treatment  has 
been  applied.  If  on  the  other  hand  he  exerts  pressure  in  the  upper 
thoracic  region  and  relieves  a  temporary  palpitation  or  thoracic 
distress,  a  palliative  treatment  has  been  employed.  Often  no  definite 
dividing  line  can  be  made  between  the  two,  for  a  corrective  treat- 
ment is  in  a  large  number  of  cases  palliative  also.  The  adjusting  of 
the  ribs  by  the  treatment  in  the  thoracic  region,  thereby  taking 
oft  the  pressure,  will  give  relief  to  the  distressed  cardiac  structures. 
On  the  other  hand  in  numerous  cases  a  palliative  treatment,  while 
given  explicitly  for  the  purpose  of  temporarily  overcoming  a  symp- 
tom, may  in  the  long  run  be  corrective  as  well.  A  treatment  applied 
for  the  purpose  of  lessening  the  intensity  of  pain  will  in  occasional 
cases  give  to  the  organism  a  better  opportunity  for  repair,  which 
was  wanting  so  long  as  the  nerve  disturbance  continued.  Further, 
it  may  become  necessary  that  a  palliative  treatment  be  given  in  order 
that  the  primary  cause  may  be  reached.  For  instance,  an  obstruc- 
tion to  the  bowel  from  impaction  may  cause  such  a  tension  of  the 
abdominal  wall  as  to  make  impossible  any  direct  manipulation 
of  the  impacted  area.  In  such  a  case  treatment  would  be  given  for 
the  purpose  of  relaxing  the  abdominal  muscles  which  would  be  pre- 
paratory to  the  primary  or  corrective  treatment.  Or  in  the  case 
of  a  wrenched  spine  the  resulting  congestion  and  contracture  of 
the  superficial  spinal  muscles  may  be  such  as  to  hinder  treatment 
to  the  deeper  structures,  making  it  advisable  if  not  essential  to 
quiet  the  sensory  disturbance  and  overcome  the  contractured  con- 
dition before  attempting  the  deeper  work.  Again,  a  palliative 
treatment  may  be  essential  as  a  preliminary  to  further  diagnosis. 
In  appendicitis  the  bowel  wall  is  so  irritable  and  tense  as  to  prohibit 
palpation  deep  enough  to  determine  the  condition  of  the  caecum 


132  PRINCIPLES  OF  OSTEOPATHY 

and  appendix ;  or  the  superficial  cervical  tissues  may  be  so  contract- 
ured  as  to  prevent  the  detection  of  a  deep  cervical  lesion.  In  both 
of  these  cases  the  palliative  or  temporary  treatment  is  necessary 
before  a  satisfactory  diagnosis  is  possible. 


CHAPTER  XXIX 

ADJUSTMENT  OF  OSSEOUS  LESIONS 

The  statement  has  been  made  that  the  three  common  forms 
of  lesion,  bony,  muscular  and  ligamentous,  are  usually  associated 
in  the  production  of  the  same  disorder.  In  the  treatment  of  the 
condition  a  movement  which  affects  one  affects  the  others.  In  the 
case  of  the  bony  and  the  muscular  lesion  at  least,  special  and  pecul- 
iar methods  are  used.  The  ligamentous  lesion  can  be  affected  only 
by  work  upon  the  others.  Since  we  do  find  bony  and  muscular 
lesions  associated  the  question  arises  as  to  which  should  have  pre- 
cedence in  point  of  time.  It  must  be  confessed  that  there  is  a 
difference  of  opinion  regarding  the  matter.  If  the  bony  disorder  is 
secondary  to  the  muscular  tension  and  is  maintained  in  its  position 
primarily  by  that  muscular  tension,  manifestly  the  muscles  should 
first  be  relaxed,  and  if  no  other  cause  of  bony  displacement  be  pres- 
ent that  may  be  sufficient.  Such  a  condition  is  a  common  occurrence 
in  acute  cases  and  hence  the  general  rule  that  muscle  contracture 
should  have  first  attention  in  acute  cases  may  be  safe  enough  to 
follow.  In  chronic  conditions,  however,  the  vast  majority  of  cases 
present  bony  disorder  not  primarily  maintained  by  muscular  con- 
tracture; and  in  most  cases  the  muscle  contracture  is  secondary  to 
the  bony  disorder  though  in  the  beginning  muscular  contracture 
may  have  been  primary.  In  such  cases  as  these  the  author  is  per- 
sonally convinced  that  direct  treatment  to  the  muscles  is  secondary 
in  point  of  time  and  importance,  and  so  far  as  actual  results  are 
concerned  the  massage  so  often  employed  is  entirely  superfluous*- 
The  discussion  will  be  begun  therefore  with  a  consideration  of  a 
few  general  principles  underlying  the  adjustment  of  the  osseous 
lesion. 

Exaggeration 

The  first  of  these  principles  may  be  spoken  of  by  the  phrase 
which  osteopathic  usage  has  authorized,  exaggeration  of  the  lesion. 
By  this  is  meant  a  manipulation  designed  to  make  the  structure 
more  prominent  in  the  direction  toward  which  it  is  displaced.    For 

133 


134  PRINCIPLES  OF  OSTEOPATHY 

instance  if  there  be  a  right  lateral  subluxation  of  a  cervical  verte- 
bra the  head  should  be  flexed  to  the  left  and  pressure  applied  to 
the  cervical  tissues  on  the  left  of  the  displaced  bone;  if  a  rib  is 
subluxated  upward  on  the  transverse  process  of  the  vertebra,  pres- 
sure is  exerted  upward  at  the  angle  of  the  rib  and  downward  on 
tlie  anterior  extremity ;  if  the  innominatura  be  subluxated  through 
a  rotation  upward  and  forward,  pressure  is  exerted  in  an  upward 
and  forward  direction  on  the  iliac  portion  of  the  bone,  upward  and 
backword  on  the  ischium.  In  the  exaggeration  of  the  lesion  several 
objects  may  be  had  in  view.  In  the  first  place  the  measure  tends 
to  free  the  articular  structures,  just  as  driving  in  a  trifle  may  free 
the  articulation  of  a  nail  with  wood  in  which  it  is  imbedded  and  per- 
mit it  to  be  withdrawn  more  easily.  In  the  second  place  the  move- 
ment effects  a  stretching  and  relaxation  of  the  deeper  structures 
which  in  numerous  cases  is  all  the  relaxation  that  is  called  for. 
Finally,  there  is  secured  the  benefit  of  recoil  which  results  from 
the  stretching  of  the  tissues  and  aids  in  initiating  the  movement 
backward  towards  the  normal  position. 

Rotation 

A  second  general  principle  is  that  of  rotation.  The  value  of 
rotation  can  hardly  be  overestimated  although  the  rotation  itself 
may  easily  be  too  extreme.  In  effecting  rotation  of  the  part  dis- 
turbed, at  some  point  during  the  circuit  each  of  the  fibres  in  each 
of  the  ligamentous  and  other  connective  structures  will  have  been 
stretched  and  relaxed  and  the  articular  surfaces  kept  sufficiently 
free  to  allow  the  progress  of  the  part  back  to  its  original  position. 
The  comparison  may  be  crude  but  the  conditions  in  the  case  are 
similar  to  the  movement  of  a  trunk  or  box  along  a  platform  by 
rocking  it  back  and  forth  with  some  rotation.  The  advantage  of 
this  method  over  that  of  dragging  the  box  bodily  is  obvious. 

Pressure 

A  final  general  principle  in  the  adjustment  is  the  simple  one 
oi  pressure  applied  to  the  displaced  structure  in  the  direction  toward 
its  normal  situation.  In  point  of  time  the  exaggeration  of  the 
lesion  is  first,  rotation  and  pressure  follow  and  are  co-extensive 
and  co-ordinate  in  time.    In  all  but  a  comparatively  few  cases  these 


ADJUSTMENT  OF  OSSEOUS  LESIONS  •     135 

three  principles  can  be  applied  with  advantage,  and  are  applied 
although  the  physician  himself  may  not  have  been  aware  of  their 
application.  In  a  few  eases  little  direct  pressure  can  be  satisfac- 
torily made,  and  in  case  of  an  anterior  lumbar  vertebra,  it  is 
necessary  to  rely  principally  upon  the  tension  of  tissues  in  and 
following  the  process  of  rotation.  In  other  cases  the  exaggeration 
of  the  lesion  may  not  be  feasible;  but  in  no  case  is  it  impossible 
to  apply  rotation  and  in  numerous  conditions  where  the  lesion  is 
slight,  that  of  itself  is  sufficient  aid  to  the  organism  in  affecting  a 
normal  adjustment. 


CHAPTER  XXX 

ADJUSTMENT  OF  MUSCULAR  LESIONS 

In  most  cases  of  a  chronic  nature  and  in  practically  all  acute 
cases  muscular  lesions  are  quite  manifest.  It  is  not  necessary  at 
this  time  to  discuss  the  question  as  to  whether  that  lesion  is  primary 
or  secondary;  the  fact  that  it  exists  calls  for  discussion  as  to  the 
methods  of  producing  relaxation.  For  whether  the  lesion  be  pri- 
mary or  secondary  its  removal  is  seldom  if  ever  contraindicated. 
Note  first  that  one  or  more  of  several  purposes  may  be  had  in  view 
of  the  relaxation. 

Relaxation  for  Diagnosis 

One  of  the  objects  in  such  relaxation  is  that  of  diagnosis.  In 
a  large  number  of  cases  the  muscular  lesion  is  the  most  apparent 
one,  which  fact  has  given  rise  to  much  hasty  reasoning  with  the 
conclusion  that  no  additional  factors  were  present.  The  writer 
was  once  told  when  he  was  a  student  in  school,  that  when  he  "got 
into  the  field"  he  would  find  little  beside  muscular  lesions.  He 
is  compelled  to  testify  that  the  informant  has  proved  himself  a 
false  prophet;  if  care  be  taken  in  analysis  of  conditions  few  acute 
or  chronic  cases  can  be  found  present  unassociated  with  deeper  than 
muscular  lesions.  Indeed  it  is  not  unsafe  to  assert  that  in  most  cases 
the  muscular  contracture  is  direct  evidence  of  a  deeper  lesion.  The 
difficulty  of  detection  may  be  much  more  marked  than  the  realness 
of  the  lesion.  The  fact  that  a  deeper  lesion  is  usually  associated 
makes  it  necessary,  or  at  least  in  many  instances  helpful,  to  effect 
a  superficial  relaxation  in  order  to  detect  the  deeper  condition. 
Note  the  case  of  a  contractured  cervical  region.  In  such  the  osteo- 
path may  not  be  able  to  determine  the  condition  of  the  cervical 
vertebrai  until  the  obscuring  muscle  contracture  is  removed.  It  is 
often  difficult,  further,  to  detect  the  relative  position  of  the  posterior 
part  of  a  rib  at  its  junction  with  the  transverse  process  of  the 
vertebra  until  the  associated  contracture  is  overcome. 

A  iioating  kidney  as  a  lesion  is  often  obscured  by  contracture  of 
the  quadratus  lumborum  and  abdominal  muscles.  Not  only  for  diag- 
nosis of  further  lesion  is  removal  of  contraction  and  contracture 
necessary,  but  also  for  determination  of  the  organ  involved  and 

136 


ADJUSTMENT  OF  MUSCULAR  LESIONS  137 

the  nature  of  the  involvement,  in  other  words,  for  diagnosis  of  the 
disease  itself.  Note  the  fact  that  in  hepatic  colic  from  the  passage 
of  a  gall-stone,  muscle  contraction  is  so  intense  and  painful  that 
a  palliative  relaxation  becomes  imperative  for  definite  diagnosis  of 
the  gall-stone  condition;  similarly  an  obstruction  to  the  bowel  pro- 
duces secondary  abdominal  tenseness  sufficient  to  prohibit  palpation; 
the  rectal  and  vaginal  sphincters  may  be  so  constricted  as  to  hinder 
local  examination  of  the  position  and  condition  of  the  uterus.  In 
all  such  cases  the  osteopath  often  finds  it  necessary  to  resort  to  the 
removal  of  the  secondary  obscuring  lesions  before  he  is  able  to  make 
a  satisfactory  diagnosis  of  the  disease. 

Relaxation  as  Preliminary  to  Treatment 

A  second  object  is  as  a  preliminary  to  further  treatment.  Dr. 
Still  invariably  allowed  his  fingers  or  palms  to  ' '  sink  in ' '  the  tissues 
for  a  moment  previous  to  the  movement  for  adjustment  of  a  cervi- 
cal vertebra;  in  this  "sinking  in"  relaxation  occurs  which  reduces 
the  vaso-motor  mechanism  to  the  part  involved.  Relaxation  of  the 
pressure.  In  long  standing  cases  of  hip  dislocation  where  a  crude 
new  articulation  has  been  formed  with  a  consequent  adjustment — 
shortening  and  lengthening — of  muscle  and  ligament,  it  is  impossible 
to  immediately  reduce  the  dislocation,  and  recourse  must  be  had 
to  a  series  of  treatments  designed  to  relax  and  otherwise  change 
structural  conditions  which  are  secondary  to  the  original  disloca- 
tion. In  bowel  occlusion  from  impaction  of  feces,  relaxation  of 
the  abdominal  wall  is  essential  to  a  further  direct  manipulation  of 
the  impacted  area. 

Relaxation  of  Primary  Lesions 

Finally,  relaxation  is  used  as  a  treatment  primary  in  itself.  A 
muscle  contracture  whether  primarily  or  secondarily  produced 
exerts  pressure  on  tissues  within  itself,  (e.  g.,  sensory  nerve  ter- 
minals) or  disturbs  structures  to  which  it  is  attached.  As  instance 
of  the  former  note  the  conditions  of  congestion  produced  in  the 
respiratory  canal  by  virtue  of  contractures  irritating  afferent  nerves 
which  carry  impulses  to  the  segment  of  the  spinal  cord  governing 
the  vaso-motor  mechanism  to  the  part  involved.  Relaxation  of  the 
muscle  tissue  in  such  a  case  removes  the  primary  cause  of  the  con- 
gestion.    By  the  tension  upon  the  associated  vertebra  or  rib,  dis- 


138  PRINCIPLES  OF  OSTEOPATHY 

placement  of  the  latter  further  adds  to  the  diflficulty  and  hence  is 
additional  cause;  in  this  case  the  relaxation  permits  of  a  return 
of  the  displaced  structures  to  their  natural  relationship.  Further 
instances  are  relaxation  of  supra-hyoid  muscles  which  interfere  with 
venous  return  from  various  cephalic  structures,  thus  relieving  con- 
gestion; pressure  on  the  bowel  wall  in  a  spasmodic  contraction  of 
the  muscular  coats  which  relaxes  the  tissue  and  overcomes  the 
cramp  which  so  distresses. 

Methods 

With  regard  to  the  methods  employed  in  producing  relaxation 
several  are  in  vogue  by  different  osteopaths.  Among  them  mention 
may  be  made  of  the  most  important.  The  removal  of  the  cause 
constitutes  in  all  cases  the  fundamental  method.  Owing  to  the 
tendency  on  the  part  of  students  to  overlook  the  fact  it  seems  neces- 
sary to  emphasize  that  a  contracted  muscle  remains  in  that  state 
only  by  virtue  of  a  continuously  acting  stimulus.  A  muscle  in  a 
state  of  rigor  may  remain  in  that  state  indefinitely,  or  until  cor- 
rect circulation  removes  the  abnormal  fluids  from  around  its  cells. 
One  of  the  inherent  properties  of  muscle  tissue  is  the  ability  to  re- 
spond to  a  stimulus  by  a  contraction.  It  is  no  less  an  inherent 
property  of  that  tissue  to  relax  as  soon  as  the  stimulus  is  removed. 

In  muscular  rigor,  the  removal  of  the  cause  of  edema,  the  res- 
toration of  normal  circulation  and  normal  alkalinity  of  the  fluids, 
the  restoration  of  normal  innervation,  permit  the  injured  cells  to 
return  to  normal  conditions,  unless  the  rigor  has  persisted  so  long 
as  to  cause  deflnite  over-growth  of  connective  tissues  and  atrophy 
of  muscle  cells, — the  condition  of  contracture  in  the  common  signifi- 
cance of  that  term. 

With  a  certain  proportion  of  students  and  inexperienced  osteo- 
paths the  first  consideration  on  meeting  with  a  case  presenting  con- 
tracture is  the  application  of  methods  direct  to  the  muscle  designed 
to  produce  relaxation.  This  is  fundamentally  erroneous.  The  first 
consideration  should  be  the  determination  of  the  nature  and  source 
of  the  constantly  acting  stimulus.  The  second  consideration  should 
be  the  application  of  measures  to  remove  that  stimulus.  If  a  muscle 
is  contracted  through  simple  exposure  to  a  change  of  temperature 
the  primary  treatment  is  the  negative  one  of  removing  the  patient 
from  the  influence  of  the  changing  temperature.  If  the  contraction 
or  contracture  is  caused  by  a  direct  irritation  to  the  motor  nerve 


ADJUSTMENT  OF  MUSCULAR  LESIONS  139 

through  pressure  from  a  deep  bony  or  ligamentous  lesion,  the  essen- 
tial treatment  consists  in  opening  up  the  space  which  transmits  the 
nerve.  A  contractured  condition  of  the  anterior  muscles  of  the 
thigh  caused  by  impingement  upon  the  anterior  crural  is  logically 
and  surely  overcome  by  the  adjustment  of  the  subluxated  hip,  pelvic, 
or  lumbar  structures  causing  the  impingement.  Note  that  the  direct 
work  upon  the  muscle  in  any  of  these  cases  will  be  getting  at  the 
difficulty  from  the  wrong  side  and  can  only  indirectly  and  in  most 
cases  temporarily  reduce  the  contracture. 

Pressure 

Admitting  the  logic  of  the  above  considerations  it  yet  remains 
a  fact  that  specific  methods,  other  than  those  directly  concerned 
in  the  way  indicated  above,  may  be  employed  as  a  matter  of  exped- 
iency. Pressure  with  quiet  and  slight  rotation  of  the  tissues,  usually 
more  in  a  direction  at  right  angles  to  that  of  the  fibres  than  other- 
wise, is  employed  in  numerous  cases.  This  method  secures  normal 
condition  of  the  muscle  by  acting  upon  its  fluids.  Venous  blood  is 
forced  out,  and  arterial  blood  returns;  edematous  fluids  are  carried 
away ;  alkalinity  is  brought  to  normal  by  the  blood  flow,  the  tension 
due  to  turgor  diminishes,  and  the  muscle  resumes  its  normal  meta- 
bolism. 

As  examples  of  cases  in  which  the  pressure  and  manipulation 
method  is  efficacious  are  the  following :  in  headache  the  suboccipital 
region  is  often  found  quite  tense,  in  which  case  gradual  but  deep 
pressure,  a  "sinking  in"  as  Dr.  Still  calls  it,  forces  the  tissue  to 
relax  and  often  yields  immediate  relief.  In  case  of  the  passage  of 
a  gall-stone  along  the  duct  the  irritation  is  so  intense  as  to  cause 
direct  connection  along  the  duct,  the  abdominal  wall  overlying  it, 
and  the  spinal  region  from  which  it  is  innervated,  in  which  case 
pressure  is  used  botTi  along  the  spine  and  the  course  of  the  duct. 
In  croup  and  diphtheria  the  rapid  inflammation  and  associated  toxic 
condition  cause  rapid  and  intense  contraction  and  congestion  of  the 
supra-hyoid  muscles,  which  will  in  most  cases  rapidly,  though  per- 
haps temporarily,  yield  to  the  pressure  and  manipulation. 

Stretching 
Stretching  the  muscle  is  a  method  that  is  employed  by  many  oste- 
opaths for  the  purpose  of  producing  relaxation.     It  is  doubtful 
whether  such  a  method  usually  results  satisfactorily.    Theoretically 


140  PRINCIPLES  OF  OSTEOPATHY 

there  is  much  to  be  said  against  the  process.  The  process  of  stretch- 
ing a  muscle  is  one  method  of  increasing  the  irritability  of  the 
muscle.  Lombard  is  authority  for  the  statement  that  "the  irritabil- 
ity of  muscles  is  likewise  increased  by  moderate  stretching  and  des- 
troyed if  it  be  excessive."  Hence  it  would  certainly  seem  illogical 
to  attempt  relaxation  by  increasing  its  irritability.  Neither  would 
it  be  the  part  of  wisdom  to  destroy  the  irritability  by  excessive 
stretching.  A  muscle  in  the  condition  of  contracture  will  be  stimu- 
lated to  still  greater  contraction  by  throwing  it  out  of  tension  and 
yet  there  seems  to  be  no  question  that  in  a  certain  percentage  of 
cases  the  process  does  result  favorably  and  the  explanation  is  sought. 
The  stretching  of  a  muscle,  thus  increasing  its  tension,  corresponds 
in  a  way  to  the  exaggeration  in  case  of  an  osseous  lesion,  and  in 
that  case  there  is  secured  the  benefit  of  recoil.  In  addition  refer- 
ence is  again  made  to  the  fact  that  muscle  contracture  is  not  iden- 
tical with  muscle  contraction,  and  in  the  process  of  stretching, 
the  congested  material  and  waste  products  are  more  or  less  forci- 
bly expressed  from  the  contractured  tissue,  though  no  relaxing 
effect  might  be  gotten  on  a  simple  contraction.  In  all  cases  when 
attempting  relaxation  by  this  method  a  simple  rule  of  guidance 
is  usually  sufficient.  Separate  the  origin  and  insertion  of  the  muscle. 
Ill  case  the  scaleni  muscles  are  found  contractured  on  the  left  side, 
bending  the  head  to  the  right  with  the  shoulder  a  fixed  point  sep- 
arates the  attachments  and  hence  produces  stretching.  Hyper-exten- 
sion of  the  thigh  stretches  the  anterior  femoral  muscles,  while  ex- 
treme flexion  of  the  thigh  on  the  abdomen  puts  tension  on  the  pos- 
terior muscles  of  the  limb.  Pulling  the  middle  portion  of  a  muscle 
in  a  direction  transverse  to  the  course  of  its  fibers  produces  tension 
of  the  muscle  although  the  absolute  distance  between  the  two  attach- 
ments of  the  muscle  actually  may  have  been  lessened,  as  in  the  case 
of  an  upward  and  outward  manipulation  of  the  spinal  muscles  in 
the  region  of  the  lower  thoracic. 

Approximation 

Another  method  less  subject  to  abuse  is  that  of  approximation 
of  tlie  origin  and  insertion.  In  this  method  the  attached  structures 
are  forced  toward  each  other.  That  this  method  is  efficacious  as  a 
temporary  expedient  few  will  deny.  Just  as  the  tension  can  be  re- 
moved from  a  rope  attached  to  posts  by  bending  the  posts  toward 
cacli   other,  so  to  an  appreciable  extent  can  the  tension  be  taken 


ADJUSTMENT  OF  MUSCULAR  LESIONS  141 

from  a  muscle  by  forcing  nearer  together  the  points  of  attachment. 
Further,  this  method  seems  to  be  a  most  natural  one,  and  one  re- 
sorted to  involuntarily  in  many  cases.  Note  the  characteristic  po- 
sition assumed  by  a  victim  of  peritonitis  in  which  the  superficial 
abdominal  tissues  are  intensely  tightened.  The  patient  lies  supine 
with  the  limbs  flexed  at  the  hip  and  the  head  and  shoulders  raised, 
the  total  effect  on  the  musculature  of  the  abdomen  being  an  approxi- 
mation of  the  origin  and  insertion  of  most  of  the  muscles  concerned. 
A  further  instance  indicating  the  value  of  this  method  is  the  flexing 
of  the  head  dorsally  upon  the  neck  in  a  case  of  suboccipital  con- 
traction; or  the  flexion  of  the  arm  at  the  elbow  for  the  purpose  of 
relaxing  the  biceps  preliminary  to  the  reduction  of  a  dislocated 
shoulder. 

It  is  seldom  that  any  one  of  these  several  methods  is  used  alone 
and  it  is  in  comparatively  few  cases  that  it  is  possible  or  advisable 
to  avoid  using  two  or  more  of  them.  For  instance  in  the  case  of 
a  eontractured  scalenus  muscle  a  common  method  is  first  to  bend  the 
head  away  from  the  side  of  the  contracture,  which  stretches  the 
muscle,  then  to  rotate  it  back,  which  approximates  the  origin  and 
insertion,  and  at  the  same  time  to  exert  pressure  directly  upon 
the  muscle  fibres.  Tn  this  case  three  of  the  methods  are  employed 
and  it  is  altogether  likely  that  during  the  course  of  the  movement 
the  deeper  structures  are  opened  up,  impingement  taken  off  the  nerve 
which  supplied  the  muscle,  and  hence  the  irritation  removed  and  a 
fourth  method  employed.  The  point  was  emphasized  in  the  case  of 
the  method  by  pressure  that  the  application  should  be  gradual.  It 
is  equally  true  of  the  other  methods,  and  not  only  with  reference 
to  the  application  but  the  removal  of  contact  should  be  gradual  for 
if  the  removal  be  sudden  there  results  an  abrupt  change.  Abrupt 
change,  whether  from  a  lower  to  a  higher  or  from  a  higher  to  a 
lower  level,  constitutes  a  stimulus,  and  a  stimulus  means  further 
contraction.  Another  caution  of  some  considerable  value  has  refer- 
ence to  the  relative  temperature  of  the  hand  of  the  physician.  If 
the  manipulation  is  made  upon  the  tissues  it  is  necessary  for  best 
results  that  the  temperature  of  the  part  and  of  the  physician's  hand 
should  be  approximately  the  same.  Especially  is  it  advisable  if  tLe 
physician  has  cold  hands  to  warm  them  before  beginning  the  treat- 
ment, otherwise  the  shock  produced  by  the  dift'erence  in  temperature 
will  be  a  distinct  added  stimulus  for  further  contraction,  a  result 
not  at  all  to  be  desired. 


CHAPTER  XXXI 

TREATMENT  OF  OTHER  LESIONS 

Thus  far  there  has  been  discussed  certain  general  principles 
underlying  the  treatment  of  bony  subluxations  and  muscular  con- 
tractures or  rigors.  It  becomes  necessary  to  suggest  a  few  points 
of  practical  value  in  regard  to  the  other  forms  of  lesion  which  the 
osteopath  must  often  meet.  In  all  of  those  cases  of  perverted  size 
relations  of  parts,  the  physician  has  to  deal  with  some  nutritive  dis- 
order responsible  for  the  perverted  growth  lesion,  and  hence  in  such 
cases  it  is  necessary  to  seek  the  further  lesion  or  other  cause  of  the 
nutritive  condition  and  give  attention  to  its  reduction.  In  a  second 
class  of  cases  the  lesion  of  perverted  growth  has  resulted  from  di- 
rect violence  producing  a  bruise  or  other  enlargement  in  which  the 
same  considerations  of  treatment  apply.  The  reduction  of  these  is 
largely  accomplished  through  dependence  on  normalizing  all  of  the 
associated  structures  and  relying  on  normal  processes  of  absorption 
to  remove  the  surplus  material. 

Tumors 

In  some  cases  it  is  necessary  to  resort  to  surgical  removal.  A 
tumor  of  the  abdomen  is  a  perverted  structure  which  by  pressure 
upon  the  hypogastric  plexus  or  other  vital  structure  may  produce 
disorder  of  various  forms.  The  treatment  of  such  a  lesion  depends 
upon  the  condition  of  the  patient.  Correction  of  every  cause  of 
disturbed  circulation  and  innervation,  and  perhaps  the  surgical  re- 
moval of  the  tumor  itself,  are  indicated,  according  to  the  nature  of 
the  neoplasm,  the  effects  produced  by  its  pressure  upon  neighboring 
organs,  and  the  prospects  of  its  becoming  diminished  or  its  assum- 
ing rapid  and  malignant  development.  Overgrown  muscles  and 
exostoses  have  been  known  to  cause  disorder  by  direct  obstruction 
and  hence  are  considered  as  lesions ;  the  removal  of  such  will  depend 
upon  the  same  factors  which  are  suggested  in  reference  to  the 
tumor. 

Connective  Tissue  Lesions 

The  overcoming  of  connective  tissue  lesions  is  a  matter  of  no 

142 


TREATMENT   OF   OTHER    LESIONS  143 

little  diflSculty.  A  typical  lesion  of  this  type  is  found  in  the  rigid 
spine  more  or  less  normal  to  the  aged  individual  and  often  met  with 
in  younger  people  who  have  suffered  from  some  violence.  This  rigid 
spine  condition,  where  it  is  not  of  a  temporary  nature  such  as  would 
be  produced  by  simple  muscle  contraction,  is  caused  by  a  thickening, 
contracting  and  lessening  of  the  fibrous  and  other  ligamentous  struc- 
tures associated  with  the  vertebrae;  or  by  a  deposit  in  the  articular 
structures  of  various  substances,  as  in  the  case  of  chronic  gout  and 
articular  rheumatism;  or  finally,  a  condition  of  bony  ankylosis.  In 
all  of  these  cases  it  is  a  serious  question  whether  a  complete  cure  can 
be  effected  or  very  great  benefit  given,  owing  to  the  difficulty  of  re- 
moving such  lesion  by  any  known  methods.  In  most  cases  it  will 
largely  be  a  "breaking  up  process"  designed  to  open  up  the  deep 
structures,  thereby  overcoming  tension  on  nerve  and  blood-vessel 
and  permitting  a  free  opportunity  for  absorptive  processes  to  be 
maintained. 

A  further  type  of  connective  tissue  lesion  is  found  in  the  case  of 
cirrhosis  of  the  liver  where  the  connective  tissue  framework  has 
been  formed  in  excess  and  has  subsequently  contracted,  thereby 
reducing  quite  appreciably  the  total  volume  of  that  organ  and  very 
considerably  obstructing  the  portal  circulation  and  the  metabolic 
activities  of  the  liver.  In  the  case  of  sclerosis  of  the  spinal  cord 
we  have  also  a  connective  tissue  lesion  of  a  serious  nature.  In  this 
case  the  neuroglia  of  the  cord  is  thickened  and  contracted  produc- 
ing or  following  a  degeneration  of  the  nerve  elements.  In  both 
cirrhosis  and  sclerosis  the  outlook  for  removal  is  unfavorable.  For 
we  know  that  while  a  regeneration  of  nerves  does  take  place  in 
peripheral  structures,  there  are  as  yet  no  authentic  cases  of  regen- 
eration of  the  lierve  fibres  in  the  spinal  cord.  All  that  can  be 
reasonably  expected  in  such  conditions  is  the  limiting  of  the  further 
progress  of  the  disease  and  a  partial  absorption  of  the  morbid 
deposit  by  establishing  and  maintaining  a  normal  spinal  circulation. 


CHAPTER  XXXII 

Time  Required 

A  few  questions  of  general  interest  invariably  arise  in  the  mind 
of  the  student  with  regard  to  the  difficulty  experienced  in  over- 
coming the  lesion,  the  time  required  to  effect  a  cure,  and  the  fre- 
quency and  length  of  treatment,  and  it  seems  advisable  to  note  a 
few  of  the  facts  which  enable  us  to  explain  the  varying  results  ob- 
tained, and  suggest  the  factors  necessary  to  consider  in  judging 
cases,  although  it  must  be  noted  that  in  many  instances  no  rules 
are  applicable,  and  the  judgment  of  the  physician  in  connection 
with  the  peculiarities  of  the  immediate  case  will  be.  the  only  court 
of  appeal. 

The  first  to  be  noted  is  an  explanation  of  the  fact  that  lesions 
are  not  immediately  removed.  Osteopathy  has  made  its  reputation 
before  the  w^orld  perhaps  more  because  of  a  few  occasional  startling 
instances  where  a  single  treatment  has  overcome  a  case  of  long 
standing  than  by  the  vastly  greater  number  who  have  been  cured 
only  after  long  and  toilsome  effort  on  the  part  of  both  physician 
and  patient.  The  strength  of  the  system  is  derived  from  the  latter 
case  but  it  is  most  noticeably  brought  to  the  attention  of  the  world 
by  the  former.  Why  is  it  that  all  cases  are  not  of  the  quick  cure 
class?  If  the  treatment  consists  in  rearranging  the  subluxated 
parts  why  not  do  so  immediately  as  does  the  engineer  with  his  en- 
gine ?  There  are  several  facts  which  serve  to  explain  this  situation. 
En  the  first  place  the  man-machine  does  not  quickly  change  its  parts 
under  normal  conditions.  While  there  is  continuous  change  it  is 
a  process  requiring  time.  It  is  no  less  true  in  abnormal  states.  The 
vitalizing  force  carries  forward  its  work  of  repair  certainly  but 
slowly.  In  this  there  is  a  marked  distinction  from  the  man-made 
machine.  Again,  it  is  necessary  to  remember  the  conditions  pre- 
senting themselves  in  case  of  a  lesion.  When  first  produced  the 
tendency  is  to  draw  back  into  line  or  otherwise  overcome  the  abnor- 
mal part  by  the  inherent  power  of  adjustment.  In  many  cases  nature 
is  successful  in  this  effort.  In  occasional  cases  she  is  unable  to  accom- 
[tlisli  the  result  and  in  such  cases  is  the  field  of  operation  for  the 

144 


TIME   REQUIRED  145 

physician.  But  note  the  second  effort  on  the  part  of  nature.  Failing 
in  applying  adjustment  by  drawing  back  to  normal  alignment  the 
perverted  structure  she  applies  it  in  the  way  of  adjusting  the  sur- 
rounding structure  in  position  and  form  to  the  new  abnormal  one. 
This  becomes  especially  noticeable  in  case  of  hip  dislocation,  where 
it  is  known  that  the  superior  hip  muscles  have  permanently  short- 
ened while  the  inferior  ones  have  correspondingly  lengthened.  A 
general  rearrangement  of  parts  also  takes  place  in  case  of  a  vertebral 
or  a  rib  lesion,  so  that  in  numerous  cases  the  new  condition  becomes 
finally  a  normal  one  in  the  sense  at  least  of  producing  no  marked 
abnormal  functioning ;  not  normal,  however,  in  the  sense  of  the  new 
arrangement  being  as  substantial  as  the  original.  In  a  certain  per- 
centage of  such  cases  there  is  still  a  partial  failure  to  adjust  and  a 
real  and  chronic  lesion  prevails.  It  is  necessary  for  the  physician 
to  either  overcome  this  partial  adjustment  or  to  give  enough  of  aid 
by  manipulation  to  permit  a  full  adjustment  to  the  new  condition. 
In  either  case  it  is  obvious  that  some  considerable  time  is  necessary. 
Of  course  the  above  considerations  have  special  reference  to  chronic 
lesions.  In  acute  cases  much  less  time  and  fewer  treatments  will 
be  required. 

In  many  cases  the  lesion  is  not  entirely  removed,  that  is,  in  the 
sense  of  securing  a  complete  return  to  normal  of  the  perverted  part. 
This  is  less  often  true  when  we  consider  the  other  side  of  the  lesion 
idea,  the  perverted  function.  For  while  in  many  cases  the  perver- 
sion of  structure  may  not  be  entirely  overcome,  in  most  of  these 
the  perverted  function  has  disappeared.  Note  the  fact  that  as  a 
general  rule  the  function  becomes  normal  before  the  structural  per- 
version is  entirely  overcome.  This  fact  depends  on  the  power  of 
adaptability  possessed  by  the  organism.  It  is  able  to  produce  nor- 
mal function  ^nth  tools  that  are  not  as  yet  ideal.  From  this  fact 
may  be  seen  one  explanation  of  the  lesion's  incomplete  reduction. 
The  patient,  as  soon  as  he  feels  normal  and  sees  no  further  symp- 
toms of  any  disorder,  assumes  that  his  cure  is  complete ;  and  for  the 
time  and  perhaps  permanently  that  is  true.  Hence  he  refuses  longer 
to  pursue  the  treatment.  In  all  such  cases  emphasis  should  be  laid 
on  the  fact  that  the  incomplete  structural  reductions  remain  a 
weakened  condition  and  hence  are  a  continuous  menace  to  the  health 
of  the  individual  either  in  causing  a  return  of  the  original  disorder 
or  of  another  that  is  possible  from  the  same  lesion.    Further,  owing 


146  PRINCIPLES  OF  OSTEOPATHY 

to  the  partial  adjustment  that  has  taken  place  in  the  chronic  case 
the  strength  of  the  new  articulation  or  adhesions  may  be  such  as 
to  defy  the  most  persistent  treatment.  It  seems  reasonable,  how- 
ever, that  in  the  great  majority  of  cases  the  original  normal  con- 
dition of  structure  as  well  as  function  may  be  restored  provided 
opportunity  in  the  way  of  time  is  secured. 


Frequency  of  Treatment 

With  regard  to  the  frequency  of  treatment,  only  general  rules 
may  be  given.  At  the  risk  of  becoming  tiresome,  the  statement  must 
be  emphasized  that  it  is  not  the  physician  but  nature  that  heals. 
If  it  were  the  former,  one  might  be  justified  in  frequent  attempts  to 
adjust  a  part  .Since  it  is  the  latter,  time  must  be  permitted  in 
order  that  the  gradual  process  of  repair  should  take  place.  It  must 
be  remembered  that  a  condition  which  is  such  as  to  preclude  immed- 
iate adjustment  must  be  one  in  which  a  process  of  adaptation  must 
take  place  before  the  part  can  be  restored  to  its  original  position.  It 
must  be  a  growing  back  in  real  truth  and  growth  requires  both 
time  and  quiet.  If  a  beginning  can  be  made  in  reduction  at  the 
first  treatment  one  should  be  satisfied;  then  allowing  sufficient  time 
to  elapse  for  adjustment  to  the  new  conditions  that  have  been  pro- 
duced, the  process  of  repair  and  restoration  can  be  carried  forward 
with  sufficient  rapidity.  In  general  a  frequency  sufficient  to  compel 
a  continuous  soreness  throughout  the  entire  interval  is  too  great. 
In  chronic  diseases  the  average  ease  prospers  most  satisfactorily 
with  treatment  applied  two  or  three  times  per  week.  But  each 
case  must  be  a  study  in  this  sense  as  in  others.  In  some  cases  a 
greater,  and  in  many  cases  a  less  frequency  of  treatment  is  found 
most  satisfactory.  For  instance.  Dr.  Still  has  always  insisted — and 
younger  practitioners  are  learning  slowly  that  he  is  right — that  the 
ordinary  case  of  asthma  should  not  be  treated  oftener  than  once 
per  week  or  ten  days.  On  the  other  hand  acute  conditions  require 
more  frequent  attention.  In  such  the  changes  are  much  more  rapid 
both  with  respect  to  repair  and  to  the  pathological  states  that  are 
produced.  Further,  owing  to  the  latter  fact  there  are  continually 
arising  secondary  lesions  and  other  causes  of  disorder  which  must 
have  attention.  An  acute  case  usually  needs  treatment  one  or  more 
times  per  day  during  the  more  critical  periods. 


TIME  REQUIRED  147 

Length  of  Treatment 

The  considerations  in  the  above  paragraph  hold  in  part  in  regard 
to  the  length  of  the  treatment.  The  young  osteopath  invariably 
gives  more  time  to  an  individual  treatment  than  will  an  older  prac- 
titioner. It  is  characteristic  of  Dr.  Still  himself  that  he  "treats  a 
case  and  goes,"  and  his  success  is  no  less  remarkable  than  the  brevity 
of  his  treatment.  There  is  such  a  thing  as  drawing  upon  the  vitality 
of  the  patient  by  a  too  lengthy  treatment.  It  is  not  likely  a  long 
treatment  will  be  given  except  by  him  who  gives  a  general  rather 
than  a  specific  one.  For  it  takes  but  a  few  moments  to  produce 
sufficient  irritation  of  a  local  part  to  cause  serious  and  successful 
protest  on  the  part  of  the  patient.  Where  the  body  is  treated  as 
the  masseur  treats,  much  time  is  required,  but  osteopaths  are  not 
masseurs.  Cases  are  met  with  occasionally  where,  owing  on  the  one 
hand  to  lack  of  skill  on  the  part  of  the  practitioner  and  on  the 
other  to  an  extreme  tissue  tenderness  of  the  patient,  some  prelimi- 
nary treatment  may  be  necessary  before  specific  work  can  be  given. 
In  such  cases  time  may  be  used  to  good  advantage  in  somewhat 
prolonging  the  treatment.  In  nervous  individuals  any  indication  of 
hurry  on  the  part  of  the  practitioner  will  react  unfavorably  on  the 
patient. 

With  reference  to  the  rapidity  of  movement  a  caution  is  neces- 
sary. In  dealing  with  all  cases,  whether  primarily  a  lesion  of  bone 
or  other  tissue,  quick  movements  are  rarely  advantageous.  A  quick 
movement  usually  acts  as  a  stimulus  to  an  already  hyper-sensitive 
tissue.  Hence  the  tissue  is  made  to  "set"  against  the  effort  to 
move  it.  Muscles  and  other  tissues  directly  worked  upon  in  treat- 
ment are  structures  which  in  disease  conditions  change  their  shape 
and  condition  only  gradually.  The  tissue  can  be  led  but  only 
with  difficulty,  and  with  much  possible  harm  will  it  be  driven  to 
its  normal  relationships. 

There  is  a  possibility  of  harm  in  the  treatment  by  manipulation. 
The  statement  is  repeatedly  made  that  "if  osteopathy  does  you  no 
good  it  will  do  you  no  harm."  The  statement  is  interesting  in  that 
it  is  more  or  less  untrue.  Osteopathic  manipulation  properly  ap- 
plied is  not  likely  to  result  in  danger  but  in  the  hands  of  an  indi- 
vidual unacquainted  with  the  laws  of  leverage  and  the  arrangements 
of  the  levers  which  he  uses  in  most  movements,  there  is  much  pos- 


148  PRINCIPLES  OF  OSTEOPATHY 

sibility  of  harm.  While  it  is  not  true  that  the  force  sufficient  to 
reduce  a  lesion  is  sufficient  to  produce  one,  yet  there  is  enough  of 
truth  in  it  to  be  worthy  of  notice.  The  harm  may  result  because 
of  the  intensity  of  the  application.  The  intensity  may  be  either  in 
the  abruptness  or  in  the  absolute  amount  of  force  used.  There  are 
certain  leverages  in  the  body  by  which  a  sufficient  force  may  be  ap- 
plied to  rupture  the  strongest  ligament,  while  a  force  not  so  great 
but  suddenly  applied  may  easily  produce  serious  injury. 

The  harm  may  result  because  the  treatment  is  too  prolonged. 
In  such  a  case  the  tissue  either  becomes  exhausted  or  what  is  more 
common,  overirritated,  with  a  resulting  congested  or  inflamed  local 
area.  In  the  same  way  irritation  may  follow  too  frequent  treatment, 
in  which  time  for  repair  is  not  given.  Under  such  circumstances 
there  is  little  possibility  of  producing  satisfactory  results  and  much 
chance  of  causing  further  disorder. 

The  above  considerations  on  the  possibility  of  harm  from  treat- 
ment wrongly  applied  are  not  given  simply  because  of  theoretical 
reasons.  Sufficient  evidence  is  brought  forward  to  show  that  dis- 
order has  resulted.  With  ordinary  care  and  average  judgment  the 
treatment  is  entirely  harmless,  but  where  those  qualities  are  lacking 
it  may  not  be  so.  In  any  case  it  would  not  be  a  difficult  matter  to 
show  that  while  there  may  be  some  danger  associated  with  the 
administration  ol  osteopathic  treatment  it  is  infinitely  more  safe 
than  that  of  drugging. 

With  reference  to  the  method  of  the  movement  that  may  be 
employed  it  is  necessary  to  emphasize  that  probably  no  two  prac- 
titioners who  have  been  long  in  the  field  execute  a  particular  treat- 
ment in  exactly  the  same  way.  There  are  a  large  number  of  meth- 
ods in  the  employment  of  the  same  principles  of  adjustment,  each 
of  which  may,  under  certain  circumstances,  present  its  own  advan- 
tages. Individuals  differ  in  the  ease  with  which  a  movement  can 
be  executed.  Hence  it  is  illogical  for  a  teacher  to  insist  that  a 
method  must  be  employed  because  it  is  the  correct  one.  It  is  not 
necessarily  so.  The  patients  themselves  differ  quite  markedly  in 
reference  to  the  readiness  with  which  they  yield  to  particular  treat- 
ment and  it  is  found  by  experience  that  what  is  perfectly  appro- 
priate in  one  individual  may  not  be  satisfactory  in  another  although 
the  lesion  may  to  all  appearances  be  the  same  in  each  case.     True, 


TIME  REQUIRED  149 

in  all  movements  account  must  be  taken  of  the  leverage  employed; 
the  physician  must  know  the  situation  of  articulation,  the  attach- 
ments of  muscles  and  the  like.  But  he  can  only  know  these  as  they 
exist  in  the  average  case.  Every  new  case  will  present  new  condi- 
tions and  will  require  at  least  slight  differences  in  the  application  of 
treatment.  Hence  in  a  later  section  discussion  is  given  to  a  few 
common  movements  that  are  in  general  use  merely  to  emphasize 
and  illustrate  the  principles  that  underly  every  adjustment  that  is 
effective.  The  mere  imitation  of  any  physician's  peculiar  methods 
is  always  unsatisfactory.  Understand  the  forces  it  is  necessary  to 
use,  determine  in  each  case  through  what  parts  these  forces  may  be 
applied,  then  adapt  the  method  to  the  circumstances  of  the  case. 
By  following  such  a  plan  the  student  becomes  a  man  of  emergencies 
and  learns  to  use  his  mental  powers  on  each  individual  case  instead 
of  yielding  to  the  pernicious  habit  of  passing  each  of  his  cases 
through  the  routine  of  an  unvarying  set  of  manipulations. 


CHAPTER  XXXin 

STIMULATION  AND  INinBITION 

Like  all  systems  of  healing,  osteopathy  has  been  presented  by 
various  classes  of  its  advocates  in  various  disguises,  and  as  a  result 
has  been  at  times  entirely  misrepresented.  While  it  is  a  matter  of 
course  that  its  professed  enemies  should  attempt  to  mislead,  it  is 
quite  unfortunate  that  there  are  a  few  of  its  professed  followers 
who,  in  attempting  to  uphold  the  system,  have  unwittingly  placed 
it  on  a  par  with  other  systems  by  imitating  or  directly  asserting 
that  osteopathy  is  a  method  of  treatment  by  mechanical  stimulation 
and  inhibition  of  nerve  impulses.  It  cannot  be  too  strongly  empha- 
sized that  such  a  position  places  the  osteopath  on  the  same  plane 
with  all  other  schools  of  healing,  the  underlying  principle  being  the 
same  in  kind  and  differing  only  in  method.  He  who  assumes  that 
the  above  definition  of  osteopathy  is  a  new  conception  in  therapeu- 
tics and  one  which  embraces  the  essentials  of  the  osteopathic  phil- 
osophy has  not  only  failed  entirely  to  grasp  that  philosophy  but 
has  shown  an  ignorance  of  medical  history  quite  unjustified.  For 
such  history  is  replete  with  evidences  that  mechanical  stimulation 
and  inhibition  applied  by  definite  manipulations  have  long  been 
known  and  used — centuries  before  osteopathy  had  been  brought  into 
the  world.  But  with  the  rise  and  development  of  osteopathy  and 
the  newly  awakened  interest  in  drugless  systems  which  in  part  re- 
sulted from  that  development,  these  various  methods  have  been 
subjected  to  investigation  as  never  before  through  the  study  of 
literature  bearing  on  the  subject  and  the  application  of  mechanical 
measures  to  disease  conditions.  Hence,  by  a  hasty  though  not  unnat- 
ural inference,  was  deduced  the  conclusion  that  the  new  method 
was  but  a  special  modification  and  extension  of  the  old.  It  is  suflfi- 
cient  in  this  connection  to  affirm  that  stimulation  and  inhibition  as 
definite  osteopathic  procedures  are  measures  that  have  been  super- 
added to  the  original  and  primary  conception,  and  in  so  far  as  they 
may  be  used  at  all  are  insignificant  in  importance. 

The  last  statement  suggests  that  there  is  a  possible  use  for  these 
methods  and  under  the  circumstances  of  an  undeveloped  and  incom- 

150 


STIMULATION  AND  INHIBITION 


151 


plete  science  and  a  lack  of  knowledge  and  skill  on  the  part  of  the 
practitioner  the  statement  may  be  true.  Under  certain  circumstances 
it  may  be  impossible  or  impracticable  for  the  osteopath  to  apply 
specific  osteopathic  treatment  and  in  such  cases  it  will  be  expedient 
for  him  to  place  himself  upon  the  same  plane  with  the  practitioner 
of  other  schools  and  use  the  least  objectionable  of  the  methods  of 
the  latter.  In  order  to  understand  the  nature  and  possible  value 
of  these  methods  it  seems  advisable  to  speak  of  them  somewhat  in 
detail. 

By  stimulation  of  a  nerve  or  an  organ  is  meant  the  process  of 
acceleration  of  the  function  of  that  nerve  or  organ.  By  inhibition 
is  meant  the  process  of  retarding  the  function  of  a  nerve  or  organ. 
Both  of  these  processes  are  attributes  of  normal  living  tissue,  more 
especially  of  the  nervous  system.  The  voluntary  contraction  of  a 
muscle  is  a  normal  or  physiological  stimulation  of  that  muscle;  the 
effect  of  food  on  the  gastric  mucosa  is  a  normal  stimulation  of  the 
function  of  secretion;  the  excess  of  carbon  dioxid  in  the  blood  is 
a  physiological  stimulus  to  the  respiratory  center.  On  the  other 
hand  a  voluntary  impulse  sent  to  the  spinal  cord  center  which  cuts 
off  the  reflex  movement  that  would  otherwise  occur  is  an  instance 
of  a  physiological  inhibition;  the  vagus  nerve  carries  inhibitory 
fibres  to  the  heart  muscle  which  retards  the  activity  of  that  tissue; 
impulses  passing  by  way  of  the  sympathetic  filaments  to  the  mus- 
cles within  the  wall  of  the  intestinal  tract  causing  a  slower  peris- 
talsis are  spoken  of  as  viscero-inhibitory.  These  are  all  examples 
of  the  physiological  or  natural  inhibition.  By  mechanical  stimula- 
tion or  inhibition  reference  is  made  to  the  artificial  process  which 
causes  or  is  supposed  to  cause  by  pressure  a  similar  effect.  Note 
that  the  process  is  artificial.  A  mechanical  stimulus  applied  by  the 
hand  of  the  practitioner  is  emphatically  not  a  natural  but  an  arti- 
ficial stimulus. 

It  is  said  that  the  liver  is  stimulated  by  producing  pressure 
directly  on  it  or  by  otherwise  compressing  it;  the  pneumogastric 
nerve  is  stimulated  by  pressure  along  its  course  for  the  purpose  of 
increasing  its  function  in  lessening  the  cardiac  activity;  in  prolap- 
sus of  the  rectum  the  atonic  walls  are  stimulated  by  local  treatment. 
On  the  other  hand  the  physician  inhibits  the  phrenic  nerve  for 
controlling  hiccoughs ;  pressure  exerted  along  the  splanchnic  region 


152  PRINCIPLES  OF  OSTEOPATHY 

inhibits  the  cramping  in  various  forms  of  colic;  pressure  exerted 
in  the  lumbar  and  sacral  regions  and  along  the  course  of  the  sciatic 
nerve  will  often  temporarily  relieve  sciatica. 

These  treatments  are  referred  to  as  stimulating  or  inhibitory 
and  the  assumption  made  that  it  is  in  truth  the  increasing  or  the 
lessening  of  nerve  action  by  a  direct  process.  Is  such  a  control 
possible?  The  author  has  heard  the  human  body  compared  to  the 
piano  upon  which  the  practitioner  plays,  bringing  out  the  harmony 
of  action  as  the  musician  produces  the  harmony  of  tone.  He  has 
heard  it  compared  to  an  electric  system  upon  which  the  intelligent 
osteopath  may  send  messages  and  shunt  the  currents  and  connect 
the  circuits.  The  statement  has  been  made  that  the  vital  fluids  and 
forces  of  the  body  are  absolutely  under  the  control  of  the  skillful 
operator.  The  essential  thing  lacking  in  these  comparisons  and 
statements  is  the  element  of  truth.  The  human  body  is  not  at  all 
like  a  piano,  neither  does  the  osteopath  play  upon  it  as  would  the 
musician.  It  is  not  an  electric  system  that  can  be  operated  upon 
to  any  degree  as  the  electrician  manipulates  his  batteries  or  his 
keys.  The  forces  and  fluids  of  the  body  are  fortunately  beyond 
the  control  of  the  physician,  skillful  though  he  be. 

A  few  facts  with  reference  to  anatomy  and  physiology  may  not 
be  out  of  place  as  indicating  the  insurmountable  difiiculties  in  the 
way  of  securing  the  absolute  control  suggested  above.  It  seems 
advisable  to  again  repeat  that  function  is  self  regulative  and  struc- 
ture nearly  so,  and  it  is  the  business  of  the  osteopath  to  deal  with 
structure,  not  function,  and  to  deal  with  structure  only  as  that 
structure  is  in  an  abnormal  condition.  But  can  the  nerve  be  stimu- 
lated and  satisfactory  results  follow? 


CHAPTER  XXXIV 

DIFFICULTIES  OF  DIRECT  CONTROL 

In  the  first  place  we  are  just  beginning  to  learn  the  functions 
of  nerves.  There  are  a  few  hundred  million  nerve  fibres  in  the 
human  body  the  function  of  most  of  which  are  known  only  in  part. 
It  was  thought  that  the  function  of  the  pneumogastric  in  reference 
to  the  heart  was  known  to  be  inhibitory,  yet  it  carries  also  accel- 
erator fibres.  It  was  assumed  that  the  efferent  tract  that  passes 
from  cortex  to  muscle  carries  only  an  impulse  resulting  in  con- 
traction, but  evidence  is  accumulating  to  show  that  it  carries  also 
an  inhibitory  impulse.  It  was  believed  that  the  sacral  nerves  car- 
ried motor  impulses  to  one  layer  of  muscle  tissue  in  the  rectal 
wall  and  inhibitory  impulses  to  the  other  layer,  but  Langley,  An- 
derson, and  others  have  exploded  the  "crossed  innervation"  theory. 
In  the  light  of  these  facts  as  to  the  function  of  the  nerves  it  is 
presumption  to  assume  that  any  such  marked  control  over  func- 
tions as  suggested  above  can  be  gained. 

Greater  difficulty  in  securing  a  very  complete  control  of  nerve 
action  by  direct  means  is  obvious  when  the  fact  is  noted  that  the 
same  nerve  may  have  different  functions.  Bear  in  mind  that  the 
nerve  is  not  a  separate  structure  but  is  made  up  of  an  indefinite 
number  of  nerve  fibres  each  one  of  which  may  be  associated  with 
a  distinct  and  different  action.  The  vagus,  for  instance,  has  efferent 
fibres  controlling  motion  and  vaso-motion,  secretion,  inhibition  and 
trophieity  (?),  and  efferent  fibres  associated  with  sensation,  vomit- 
ing, vaso-dilatation,  and  perhaps  a  host  of  others.  All  these  are 
bound  up  in  the  same  sheath.  Imagine  the  nicety  of  control  possi- 
ble to  the  practitioner  under  such  an  anatomical  arrangement !  Any 
efferent  nerve  may,  on  being  stimulated  by  mechanical  means,  mod- 
ify any  of  the  numerous  functions  of  a  spinal  segment.  Who  will 
direct  the  excess  of  impulse  into  the  right  channel?  Nearly  every 
nerve  that  carries  vaso-constrictor  fibres  carries  also  those  of  a 
dilator  function.  The  presumption  in  claiming  an  arbitrary  choice 
of  effects  in  vaso-motor  stimulation  is  evident. 

A  third  fact  is  noted  in  that  the  nerve  it  is  desired  to  affect 

153 


154  PRINCIPLES  OF  OSTEOPATHY 

may  nol  be  in  its  usual  situation.  The  inhibition  of  the  phrenic 
nerve  is  often  impossible  because  of  the  simple  fact  that  it  is  not 
in  the  location  where  pressure  is  applied.  Any  one  who  has  had 
occasion  to  do  much  work  in  the  dissecting  room  will  be  impressed 
with  the  numerous  exceptions  to  the  rules  of  location  of  structures. 
Attention  was  recently  called  to  a  case  showing  the  spinal  acces- 
sory nerve  passing  across  the  end  of  the  transverse  process  of  the 
atlas. 

In  close  connection  with  the  above  the  fact  should  be  noted  that 
the  vast  majority  of  nerves  are  beyond  the  possibility  of  direct 
manipulation,  a  very  wise  provision  of  nature.  Stimulating  the 
splanchnic  nerves  is  spoken  of  as  though  these  structures  were  laid 
bare  to  the  touch.  Perhaps  in  reality  there  is  produced  acceleration 
of  function  in  many  cases.  But  it  certainly  must  be  done  through 
a  very  indirect  route,  and  that  through  the  complex  arrangement 
of  a  reflex  mechanism. 

The  latter  suggests  a  fifth  very  real  difficulty  in  the  way.  Most 
stimulating  and  inhibiting  treatments  are  explained  on  such  a  reflex 
basis,  an  explanation  which  in  some  cases  seems  rather  strained. 
Note  that  in  the  stimulation  of  the  nerves  associated  with  the  spinal 
region,  for  the  purpose  of  affecting  the  splanchnic  nerves  must  pass 
l)y  the  afferent  spinal  fibres — fibres  which  have  a  choice  of  many 
neurons  to  which  their  charge  may  be  delivered.  It  is  but  a  remote 
possibility  rather  than  a  likely  probability  that  sufficient  of  the 
excess  of  stimuli  shall  reach  those  cell  bodies  whose  axons  pass  to 
form  the  splanchnic  pathways.  The  argument  that  use  is  made 
of  that  explanation  for  the  visceral  disorders  resulting  from  spinal 
muscle  contracture  does  not  particularly  enhance  the  proposition 
that  the  osteopath  can  cause  the  effect  that  is  produced  by  the  lesion. 
Note  that  the  lesion  is  either  a  much  more  intense  stimulus  or  is 
prolonged  over  a  greater  period  of  time.  Should  the  osteopath 
keep  up  continuous  stimulation  of  such  nerves  for  some  hours  suffi- 
cient excess  of  stimuli  might  be  discharged  into  the  splanchnic  chan- 
nels to  amount  to  a  real  stimulation.  But  no  such  length  of  stim- 
ulation period  is  indulged  in  by  the  average  practitioner.  Further, 
to  argue  that  the  excess  will  all  be  poured  into  the  channels  needing 
it  because  nature  "tends  to  the  normal,"  hardly  meets  the  demands. 
It  is  true  that  nature  tends  to  the  normal,  but  it  is  further  true  that 
so  far  as  function  is  concerned  the  tendency  is  in  part  toward  that 


DIFFICULTIES  OF  DIRECT  CONTROL  155 

condition  which  is  normal  to  the  existing  structure,  i,  e.,  to  that  con- 
dition which  is  permitted  by  the  existing  structure.  So  long  as 
structural  conditions  are  at  fault  the  functions  are  likely  to  remain 
so.  When  those  conditions  are  overcome  no  additional  stimulus  is 
necessary. 

A  further  difficulty  presents  itself  in  cases  where  the  stimulus 
may  be  applied  either  directly  or  reflexly.  The  intensity  of  the  stim- 
ulus cannot  be  gauged  in  proportion  to  the  need  in  the  particular 
ease.  In  laboratory  work  in  physiology  the  mechanical  stimulus 
is  seldom  made  use  of  for  this  simple  reason.  It  is  effective  but 
cannot  be  regulated  in  intensity,  hence  the  use  of  the  electric  stim- 
ulus which  is  susceptible  of  nicety  of  control.  How  much  pressure 
shall  be  employed  in  order  that  the  exact  amount  of  increase  of 
function  shall  be  produced  ?  There  can  be  no  answer  to  the  question. 
Why  not  employ  the  electric  stimulus,  then,  instead  of  the  mechan- 
ical in  osteopathic  practice  ?  For  the  very  good  reason  that  electro- 
therapists  themselves  have  tried  it  and  found  it  wanting.  And 
not  because  of  any  necessarily  harmful  effect  on  the  tissues  pro- 
duced by  the  current  as  such  but  because  the  positive  results  were 
unsatisfactory.  That  it  will  be  found  equally  true  of  the  mechan- 
ical stimulation  we  are  thoroughly  convinced. 

We  have  finally  to  mention  a  fact  that  is  of  first  importance 
and  that  is  that  in  all  cases  where  function  is  artificially  changed 
by  increase  or  decrease  there  will  be  a  recoil  in  the  opposite  di- 
rection. This  is  notably  true  with  respect  to  experimental  stim- 
ulation in  the  laboratory.  Goltz's  experiment  on  the  inhibitory 
action  of  the  cardiac  nerves  of  the  frog  is  a  case  in  point.  The 
following  is  the  description  of  the  experiment:  "In  a  medium 
sized  frog  the  pericardium  was  exposed  by  carefully  cutting  a 
small  window  in  the  chest  wall.  The  pulsations  of  the  heart  could 
be  seen  through  the  thin  pericardial  membrane.  Goltz  now  began 
to  beat  upon  the  abdomen  about  140  times  a  minute  with  the  handle 
of  a  scalpel.  The  heart  gradually  slowed  and  at  length  stood  still 
in  diastole.  Goltz  now  ceased  the  rain  of  little  blows.  The  heart 
remained  quiet  for  a  time  and  then  began  to  beat  again,  at  first 
slowly,  and  then  more  rapidly.  Some  time  after  the  experiment 
the  heart  beat  about  five  strokes  in  a  minute  faster  than  before  the 


156  PRINCIPLES  OF  OSTEOPATHY 

experiment  was  begun.  The  effect  cannot  be  obtained  after  section 
of  the  vagi."^  Note  that  the  final  effect  was  not  inhibition,  but 
stimulation. 

Some  experimentation  has  been  and  is  being  done  at  the  present 
time  by  osteopathic  investigators  to  show  that  a  direct  effect  can 
be  produced  in  ease  of  man  and  lower  animals  (rabbit)  by  stimu- 
lation and  inhibition  in  connection  with  the  cardiac  nerves  and  the 
splanchnics,  a  proposition  to  which  assent  has  already  been  given. 
While  these  explanations  seem  to  substantiate  the  proposition  that 
such  a  direct  action  is  possible  it  remains  to  be  shown  that  the 
effect  is  at  all  permanent  or  advisable,  and  more  especially  to  prove 
that  a  recoil  is  not  inevitable  or  probable.  Further  observation  of 
such  experimentation  is  awaited  with  interest.  What  is  true  in  those 
eases  in  which  accurate  experimentation  is  possible  is  reasonably 
true  of  all  others.  Any  swing  of  the  pendulum  past  the  position 
which  is  normal  under  the  existing  circumstances  will  be  compen- 
sated for  by  a  recoil  of  opposite  sign.  Note  the  fact  that  the  organ- 
ism brooks  no  interference  with  its  function  and  will  return  to  its 
normal  activity  when  it  has  by  sudden  force  been  disturbed  in  that 
activity. 

Thus  far  reference  has  been  made  to  some  of  the  difficulties 
M'hieh  beset  him  who  would  attempt  by  nerve  stimulation  or  inhi- 
bition to  secure  a  definite  control  over  the  functions  of  the  organism. 
A.dmitting  that  notwithstanding  these  difficulties  there  is  still  pos- 
sible a  limited  and  temporary  control,  it  is  necessary  to  consider 
certain  objections  to  the  use  of  these  measures,  and  also  the  con- 
ditions where  such  treatment  might  be  necessary  or  helpful. 


^Amcriean  Text-Book  of  Physiology. 


CHAPTER  XXXV 

USE  AND  ABUSE  OF  DIRECT  CONTROL 

By  stimulating  or  inhibiting  a  nerve  or  other  structure  the 
physician  interferes  with  normal  function.  It  has  before  been  sug- 
gested that  function  is  normal  to  structure.  Making  simply  a  gen- 
eral statement,  every  function,  be  it  usual  or  unusual,  is  what  it 
should  be  under  the  circumstances  of  existing  structure.  An  in- 
creased peripheral  resistance  to  the  blood  flow  causes  an  overactive 
heart.  This  latter  condition  is  normal  under  the  circumstances.  It 
must  increase  its  activity  in  order  to  keep  up  normal  circulation. 
The  attempt  to  limit  the  heart 's  action  by  inhibiting  it  is  a  distinct 
hindrance  and  an  illogical  treatment.  Suppose  that  the  peripheral 
resistance  was  maintained  so  long  as  to  exhaust  the  heart's  action. 
The  lessened  force  resulting  is  still  normal  to  the  structural  con- 
ditions. The  stomach  in  discharging  its  contents  through  the  esoph- 
agus is  performing  a  normal  function  and  so  long  as  it  can  by  that 
method  rid  itself  of  irritant  material  vomiting  should  be  unhindered. 

Note  further  that  a  stimulus  applied  to  a  failing  function  is 
in  many  cases  crowding  an  already  overworked  organ.  Notice  one 
of  the  foregoing  illustrations.  When  the  heart  by  reason  of  an 
imperfect  blood  supply,  through  lesion  or  otherwise,  is  weakened, 
the  work  it  is  performing  represents  its  capacity  at  the  time.  K 
a  stimulus  is  applied  to  the  accelerator  nerves  to  hasten  its  action, 
only  an  earlier  exhaustion  can  be  the  result.  Attention  is  called  to 
the  fact  that  the  accelerators  like  other  motor  nerves  cause  an  in- 
creased muscle  activity,  they  increase  its  tone,  its  excitability,  and 
its  conductivity,  which  in  turn  is  associated  with  a  more  rapid  kata- 
bolism.  Hence  in  causing  this  increase  only  a  more  rapid  exhaustion 
of  the  reserve  force  stored  in  the  heart  muscle  or  in  other  centers 
of  supply  is  produced.  The  same  principle  is  applied  to  each  organ 
in  the  body.  Its  function  is  not  decreased  because  of  an  inherent 
laziness,  but  because  of  the  adverse  effect  produced  upon  it  by 
incorrect  structural  conditions,  or  by  toxic  states  or  by  lack  of 
nutritive  material. 

157 


158  PRINCIPLES  OF  OSTEOPATHY 

The  reaction  may  be  as  great  as  the  original  action.  Leaving  the 
structural  conditions  as  they  are,  a  temporarily  accelerated  peristalsis 
of  the  intestine  is  followed  by  a  period  of  still  further  diminished 
bowel  activity.  Just  as  in  the  use  of  a  cathartic  a  constantly  in- 
creasing dose  is  necessary  to  produce  an  action  till  finally  it  becomes 
ineffective,  so  a  mechanical  stimulus  will  be  followed  by  a  lessening 
response.  A  stimulation  of  the  vaso-constrictors  is  followed  by  a 
great  vascular  dilatation.  An  inhibitory  treatment  for  pain  is  oc- 
casionally followed  by  a  return  of  the  sensory  disorder  in  greater 
intensity. 

In  many  cases  the  palliative  treatment  serves  only  to  conceal 
a  serious  condition.  Osteopaths  condemn  the  old  school  practice 
of  giving  morphine  for  lessening  pain  and  yet  in  numerous  instances 
make  use  of  exactly  the  same  reasoning  and  practice  with  barely 
a  thought  of  the  consequences.  The  concealment  of  a  pain  condition 
from  the  patient  by  any  treatment  without  the  removal  of  its  cause 
is  a  crime  against  the  patient,  if  the  pain  is  necessary  for  diagnosis  of 
the  case.  The  plea  that  the  patient  insists  on  it  or  that  it  gives 
nature  a  chance  for  repair  is  seldom  a  sufficient  justification.  The 
lessening  of  a  rapid  heart  beat  often  gives  a  sense  of  security  en- 
tirely unwarranted  by  the  real  state  of  that  organ.  The  "tonic" 
treatment  gives  a  temporary  sense  of  exhilaration  similar  in  kind 
if  not  in  degree  to  that  following  moderate  doses  of  morphine  or 
alcohol.  This  form  of  deception  is  little  more  justifiable  than  any 
other  and  as  often  results  disastrously. 

These  statements  do  not  apply  to  the  use  of  palliative  measures 
after  the  corrective  treatment  has  been  decided  upon,  or  in  those 
cases  in  which  fatal  outcome  is  to  be  anticipated.  Relief  of  pain 
under  such  circumstances  is  the  duty  of  any  physician. 

A  final  objection  that  is  exemplified  occasionally  is  the  fact 
that  a  treatment  habit  may  just  as  really  be  formed  as  a  drug  habit. 
In  both  cases  the  organism  eventually  tends  to  rely  on  the  artificial 
stimulus  instead  of  the  natural  one  for  its  proper  functioning.  That 
individual  who  requires  frequent  treatment  to  be  kept  in  normal 
''tone"  is  as  much  a  treatment  habitue  as  he  who  requires  the 
daily  application  of  the  needle,  a  morphine  fiend.  And  yet  many 
osteopaths  pander  to  the  temptation  by  advertising  the  value  and 
pleasure  to  be  derived  from  a  "tonic"  treatment. 


USE  AND  ABUSE  OF  DIRECT  CONTROL 


159 


But  it  would  be  incorrect  to  leave  the  impression  that  such 
attempt  at  direct  control  is  never  justified.  Experience  seems  to 
suggest  that  while  there  are  numerous  possibilities  of  ineffectiveness 
or  of  real  harm  in  such  purely  palliative  Jreatment  there  are  occas- 
ions where  such  procedures  may  be  a  choice  of  evils.  For  it  cannot 
be  denied  that  in  many  eases  stimulating  and  inhibitory  treatments 
have  been  and  will  continue  to  be  given  with  marked  benefit.  Note 
that  it  is  insisted  that  the  good  results  gotten  are  necessarily  de- 
pendent on  nerve  stimulation  or  inhibition.  To  this  phase  of  the 
question  reference  will  be  made  later.  At  present  mention  will  be 
made  of  those  cases  in  which  such  treatment  is  theoretically  or 
practically  demanded. 

Indications  for  Attempts  at  Direct  Control 

In  those  cases  where  a  lesion  is  not  apparent,  and  no  other 
known  cause  is  apparent  a  treatment  in  the  region  of  innervation 
is  often  seemingly  helpful.  In  occasional  cases  the  ordinary  prac- 
titioner will  not  be  able  to  detect  splanchnic  or  other  lesion  affecting 
the  stomach  and  yet  stomach  trouble  exists.  Treatment  applied 
in  the  lesion  region  for  such  disorders  is  effective.  A  lax  condition 
of  the  general  circulatory  mechanism  is  sometimes  seen  where  no 
definite  lesion  can  be  assigned  for  the  disorder.  A  general  spinal 
"toning  up"  is  resorted  to  with  at  least  temporary  benefit.  An  over- 
active peristalsis  is  often  checked  by  strong  pressure  in  the  lumbar 
or  lower  thoracic  region.  Pain  is  lessened  by  treatment  over  the 
structures  associated  with  the  sensory  nerve  involved. 

It  would  seem  to  be  helpful  to  apply  a  stimulus  after  removal 
of  lesion  or  other  cause.  The  analogy  is  drawn  between  the  cases 
of  a  stalled  horse  whose  progress  is  hindered  by  a  stone  in  front 
of  the  wheels  of  a  vehicle,  and  an  organ  working  against  a  hinder- 
ing lesion.  In  each  ease  the  propelling  force  has  become  discouraged. 
After  removal  of  the  stone  it  may  be  helpful  to  "touch  up"  the 
horse  with  a  whip,  and  likewise  to  "touch  up"  the  organ  through 
its  nerve  mechanism.  The  liver  is  often  directly  manipulated  by 
pressure  after  the  spinal  lesion  is  removed.  The  sluggish  kidney 
responds  to  treatment  after  the  lumbar  lesion  is  removed.  A  uterine 
headache  will  be  sooner  overcome  if  a  cervical  treatment  is  given 
following  the  adjustment  of  the  uterus  than  would  otherwise  be 
the  case. 


160  PRINCIPLES  OF  OSTEOPATHY 

In  rare  cases  removal  of  the  cause  may  be  impossible  or  imprac- 
ticable. In  such  cases  it  is  a  question  whether  to  leave  all  to  nature 
or  to  attempt  to  bring  out  any  latent  power  of  nature  that  the  con- 
dition itself  fails  to  arousg.  In  ankylosis  of  the  spine  the  lesion  is  a 
bony  union  and  as  such  is  practically  impossible  of  removal.  The 
functions  interfered  with  thereby  may  be  aided  by  occasional  treat- 
ment of  the  spinal  regions  and  of  the  involved  organs  directly.  In- 
tense nervous  or  mental  excitement  interfering  with  direct  treatment 
to  the  primary  lesion  may  be  decreased  by  pressure  applied  in  the 
suboccipital  region;  it  may  be  necessary  to  lessen  pain,  where  pres- 
ent in  such  intensity  as  to  prevent  use  of  the  various  methods  of 
diagnosis  or  treatment. 

In  some  cases  direct  stimulation  may  force  an  obstruction  and 
hence  be  a  factor  in  the  removal  of  a  lesion  as  well  as  in  overcoming 
an  effect.  Increasing  the  heart's  force  may  overcome  a  congested 
venous  or  capillary  condition.  Direct  work  over  the  liver  may  in- 
crease bile  secretion  and  thereby  assist  in  removing  obstruction  to 
the  gall-duct.  Direct  treatment  to  muscle  tissues  may  assist  in 
adjusting  the  structures  to  which  those  tissues  are  attached. 

In  occasional  instances  it  may  be  necessary  to  resort  to  heroic 
measures  in  order  to  tide  over  the  crisis.  In  case  of  a  sudden  heart 
failure  direct  pressure  over  the  solar  plexus  or  manipulation  in  the 
accelerator  region  may  assist  in  preventing  collapse;  in  case  of 
hemorrhage  an  extreme  stimulus  applied  to  the  part  may  tempor- 
arily check  the  flow ;  spasmodic  laryngitis  or  croup  may  be  prevented 
from  terminating  fatally  through  strangulation,  by  treatment  of 
the  laryngeal  and  other  structures. 

In  some  cases  it  may  be  advisable  for  the  osteopath  to  place 
himself  on  the  same  plane  with  the  old  school  physician  and  treat 
the  symptoms  as  they  arise,  for  it  is  to  be  noted  that  a  symptom 
may  in  some  cases  seem  to  be  a  distinct  hindrance  to  normal  process- 
es of  repair.  With  reference  to  pain,  while  it  is  of  value  to  the 
organism  in  numerous  ways  its  great  intensity  in  some  cases  ren- 
ders it  a  distinct  disadvantage  and  inhibition  may  become  helpful 
by  lessening  the  nerve  disturbance,  thereby  giving  the  organism  a 
bettpr  opportunity  for  repair.  An  excessively  high  temperature 
becomes  a  menace  to  the  life  of  the  individual  and  direct  treatment 
for  purposes  of  lowering  that  temperature  may  be  called  for.  The 
rapid  waste  of  the  fluids  of  the  body  in  certain  diarrhoeic  conditions 


USE  AND  ABUSE  OF  DIRECT  CONTROL  161 

contributes  to  an  undue  weakness  and  may  be  prevented  by  inhibi- 
tory treatment.  In  case  of  excessive  vomiting  when  all  is  ejected 
the  nervous  disorder  permitting  it  may  be  adjusted  by  inhibitory 
treatment. 

It  will  be  noticed  that  in  most  of  the  foregoing  cases  the  treat- 
ment partakes  largely  of  the  nature  of  a  choice  of  evils  and  suggests 
what  it  is  necessary  to  emphasize  continually,  that  these  measures 
are  only  to  be  employed  where,  in  the  judgment  of  the  physician, 
the  primary  and  logical  treatment,  removal  of  the  cause,  is  not  im- 
mediately possible  or  practicable,  and  in  those  cases  in  which  symp- 
toms persist  after  corrective  treatment. 

But  if  further  analysis  is  made  of  the  above  cases  it  will  be 
found  that  the  words  stimulation  and  inhibition  are  deceptive  in 
many  cases.  In  the  ordinary  acceptation  of  those  terms  it  would 
be  understood  that  the  function  of  the  part  disordered  was  in- 
creased or  decreased  directly  or  through  its  connecting  nerve.  But 
this  reasoning  is  erroneous.  In  the  first  set  of  conditions  referred 
to  stimulation  was  employed  where  no  apparent  lesion  was  present. 
Emphatically  that  does  not  mean  that  no  lesion  was  present.  In 
the  application  of  a  stimulating  treatment  to  the  region  of  inner- 
vation, it  is  reasonable  that  instead  of  pure  stimulation  of  those 
nerves  by  a  quick  pressure  alternating  with  relaxation  there  results 
in  reality  a  removal  of  actual  impingement  upon  nerve  or  other 
structures  which  rendered  their  activity  subnormal.  Note  a  typical 
case.  In  occasional  instances  of  constipation  no  very  distinct  spinal 
lesion  is  apparent;  all  experience  indicates  that  a  stimulating  treat- 
ment-through the  lower  thoracic  and  lumbar  regions  is  more  effect- 
ive than  is  a  quiet  pressure  treatment;  if  the  results  were  depend- 
ent upon  direct  efforts  produced  on  the  splanchnic  nerves  the  latter 
form  of  treatment  should  be  the  more  effective,  for  the  physiological 
result  of  stimulation  of  the  splanchnic  nerves  is  a  lessened  peris- 
talsis. In  such  a  case  as  this  there  is  undoubtedly  produced  an  effect 
upon  the  involved  nerves,  but  it  is  done  indirectly  through  the  re- 
moval of  pressure  conditions  in  the  spinal  region  which  were  pro- 
ducing the  existing  inhibitory  effect.  What  is  true  of  the  stimula- 
tion in  this  case  is  probably  true  in  the  vast  majority  of  cases. 
If  it  is  the  direct  stimulant  effect  on  the  nerve,  why  will  not  titilla- 
tion  of  the  skin  in  the  process  of  tickling,  or  the  application  of  an 
electric  stimulus  be  productive  of  equally  good  or  better  results? 


162  PRINCIPLES  OF  OSTEOPATHY 

In  the  second  class  of  conditions  the  analogy  between  the  horse 
and  the  organ  is  far-fetched.  While  it  is  true  that  the  horse  may 
become  discouraged  there  is  nothing  to  indicate  a  possibility  of 
a  similar  condition  in  case  of  an  organ;  on  removal  of  the  lesion 
the  disease  condition  itself  is  the  only  ** touching  up"  process  neces- 
sary to  arouse  the  entire  responsive  powers  of  the  organism.  When 
the  removal  of  the  lesion  is  impossible  the  so-called  stimulation 
may,  perhaps,  be  a  real,  though  incomplete  removal  of  a  part  of  the 
lesion  condition.  Any  breaking  up  treatment  of  the  spine  in  the 
rigid  condition  of  that  structure  opens  up  the  tissues  and  undoubt- 
edly frees  the  nerve  and  vascular  mechanism  of  the  spine  sufficiently 
to  account  for  the  benefit  that  results  from  the  treatment. 

With  reference  to  the  inhibition  of  pain  which  is  the  typical 
example  of  the  value  of  inhibition  as  a  therapeutic  measure,  a  few 
considerations  may  not  be  out  of  place.  This  proposition  is 
fundamental :  the  success  in  overcoming  any  pain  condition  is  in 
direct  proportion  to  the  amount  of  structural  adjustment  effected. 
Given  a  pain  condition  with  little  removable  structural  change  pres- 
ent, the  possibility  of  diminishing  that  pain  will  be  a  minimum; 
with  the  more  removable  structural  abnormality  associated  with 
the  pain  will  go  the  maximum  possibility  of  pain  removal.  For 
instance,  there  are  numerous  cases  of  pain  resulting  from  visceral 
disorders.  In  these  cases  there  will  be  muscle  contractures  in  the 
spinal  region  either  primary  or  secondary.  In  either  case  the  pain 
will  be  overcome  in  proportion  to  the  extent  to  which  the  muscular 
contracture  or  other  lesion  is  diminished.  Reference  has  been  made 
to  the  fact  that  in  experimental  physiology  it  is  most  difficult  to 
apply  pressure  gradually  enough  to  prevent  stimulation,  not  to 
speak  of  the  possibility  of  lessening  the  nerve  action  concerned. 

Pressure  upon  tissues  diminishes  the  amount  of  liquid  within 
their  meshes;  this  applies  to  lymph  and  blood,  as  well  as  to  ede- 
matous fluids.  When  the  pressure  is  removed,  the  fresh  arterial 
blood  flows  more  freely,  and  the  alkalinity  of  the  tissues  is  restored, 
and  edematous  fluids  are  less  freely  formed. 

Physiological  experimentation  shows  that  the  stretching  pro- 
cess at  first  renders  the  nerve  protoplasm  more  irritable;  if  long 
continued  its  irritability  becomes  lessened  or  totally  destroyed, 
in  which  ease  there  must  be  produced  a  disturbance  in  the  arrange- 


USE  AND  ABUSE  OF  DIRECT  CONTROL  163 

ment  of  the  protoplasmic  molecules  such  as  to  interfere  with  their 
normal  relationships.  Such  an  explanation  may  account  for  the 
good  effects  that  often  follow  the  stretching  of  the  sciatic  nerve 
in  so  called  sciatic  rheumatism.  The  other  explanation  is  the  more 
probable,  that,  by  the  hyper-extension  of  the  limb,  tension  of  the 
associated  structures  is  removed  with  a  resulting  lessening  impinge- 
ment upon  the  nerve  and  its  branches. 

In  summing  up  the  discussion  emphasis  is  to  be  laid  upon  the 
fact  that  the  removal  of  lesion  or  other  cause  of  disorder  constitutes 
the  logical  treatment  for  that  disorder.  When  a  structure  or  organ 
needs  stimulating  or  inhibiting,  it  can  be  done  in  but  one  proper 
way  and  that  an  indirect  way,  by  removal  of  the  cause  that  makes 
it  necessary  to  stimulate  or  inhibit.  Hence  the  two  following  sim- 
ilar propositions  may  be  formulated: 

1.  The  necessity  for  stimulation  presupposes  an  existing  inhi- 
bition; the  removal  of  the  cause  of  that  existing  inhibition  consti- 
tutes the  legitimate  method  of  stimulation. 

2.  The  necessity  for  inhibition  presupposes  an  existing  stim- 
ulation; the  removal  of  the  cause  of  that  existing  stimulation  con- 
stitutes the  legitimate  method  of  inhibition. 

These  propositions  are  fundamental  and  comprehend  the  essence 
of  the  osteopathic  view  of  the  treatment  of  disordered  conditions, 
and  are  applicable  to  the  entire  field  of  disease. 


CHAPTER  XXXVI 

TREATMENT  OF  DISEASE  CAUSED  BY  ABUSE 

In  discussing  the  causes  of  disease  attention  was  called  to  the 
fact  that  abuse  of  an  organ  or  its  function  ultimately  produces  a 
diseased  condition  of  that  organ.  What  constitutes  the  legitimate 
tj-eatinent  for  such  cases?  It  is  obvious  that  what  is  undoubtedly 
called  for  is  the  negative  treatment  of  simply  stopping  the  abuse. 
If  stomach  disorder  be  caused  by  continuous  overloading,  lessen  the 
load.  If  writer's  cramp  result  from  excessive  exercise  of  the  limited 
set  of  muscles,  stop  writing.  If  the  environment  conditions  are  such 
as  to  subject  the  individual  to  abuse  of  the  respiratory  tract,  move 
out  and  away  from  such  environment.  This  proposition  seems  valid : 
in  ease  of  disease  due  only  to  abuse  and  not  associated  with  struc- 
tural disorder,  no  positive-  manipulative  treatment  is  indicated. 
Through  ages  of  false  training  the  belief  has  become  established 
that  for  every  apparent  disorder  something  should  be  done  in  the 
way  of  definite  artificial  treatment.  Reliance  has  heretofore  been 
placed  on  the  drug.'  With  the  one  who  has  learned  of  the  efficacy 
of  osteopathic  measures  he  assumes  a  treatment  is  necessary  under 
the  similar  circumstances.  In  many  cases  he  is  right.  In  numerous 
cases  he  is  wrong.  In  those  cases  where  temporary  disorder  results 
from  manifest  abuse,  treatment  is  unnecessary  and  perhaps  harm- 
ful. In  this  regard  advocates  of  any  form  of  psychic  therapeutics 
are  essentially  correct.  Let  alone,  nature  will  be  the  all-sufficient 
factor  in  cure.  But  experience  and  reason  both  indicate  that  there 
are  limits  to  the  recuperative  power  of  nature,  and  osteopaths  em- 
f)hasize  that  in  many  cases  that  limit  is  represented  by  a  definite 
obstruction  in  the  machinery  through  which  nature  manifests  her 
curative  power.  In  such  ease  artificial  aid  is  indicated.  Note  this 
fact :  most  cases  primarily  due  to  abuse  are  not  unassociated  with 
structural  disturbance. 

In  many  cases  a  predisposing  lesion  is  present  which  represents 
a  factor  involving  definite  difficulty  in  nature's  reparative  process. 
In  other  cases  secondary  lesions  will  arise  which  add  to  the  disorder 
and  constitute  new  causal  factors.  In  both  of  these  cases  definite 
rpanipiilative  treatment  is  called  for  and  without  question  is  advan- 

164 


TREATMENT  OF  DISEASE  CAUSED   BY  ABUSE  165 

tageous.  Hence  it  is  found  that  eases  in  which  treatment  is  not 
necessary  or  helpful  are  comparatively  rare,  and  the  osteopath 
should  never  fail  to  carefully  examine  a  condition  before  he  pro- 
nounces it  a  case  requiring  no  treatment  except  the  negative  one 
of  abstinence. 

Will  a  patient  recover  under  osteopathic  manipulation  when 
he  refuses  or  is  unable  to  abstain  from  abuse?  Numerous  cases 
of  such  are  found.  Occupations  requiring  life  in  adverse  circum- 
stances of  environment  must  be  continued  by  many  in  order  that 
life  itself  may  be  supported.  The  miner  still  must  live  in  the  mine, 
the  writer  still  must  use  his  exhausted  fingers,  the  unfortunate 
must  still  use  ill-nourishing  food.  Can  such  recover?  In  countless 
cases,  yes.  In  any  case,  only  with  greater  difficulty.  As  illustration 
may  be  cited  any  number  of  cases  of  eye  trouble  that  have  been 
successfully  treated  in  osteopathic  colleges  while  the  patient  was 
taking  the  school  course,  and  was  compelled  thereby  to  abuse  his 
eyes.  So  long,  however,  as  abuse  is  the  sole  factor,  which  is  only 
an  occasional  condition,  little  can  be  done  if  the  abuse  is  continued. 

On  the  other  hand,  will  a  patient  recover,  if  predisposing  or 
secondary  lesions  be  present,  no  manipulative  treatment  be  given 
and  the  patient  simply  abstains  from  abuse?  Undoubtedly  in  a 
large  number  of  cases.  For  it  has  already  been  shown  that  while 
function  is  much  more  markedly  self-regulative  than  structure, 
yet  the  natural  processes  of  the  body  alone  are  successful,  in  many 
cases,  in  overcoming  definite  structural  changes.  This  is  the  more 
noticeably  the  case  with  reference  to  the  lesions  which  have  arisen 
as  secondary  processes  during  the  course  of  abuse  than  in  those 
cases  in  which  a  predisposing  lesion  was  present  from  the  beginning. 
In  the  latter  case  it  may  be  that  the  tendency  to  the  disorder  is  not 
overcome,  and  hence  the  condition  regained  be  that  of  the  organism 
previous  to  the  abuse;  the  lesion  with  its  associated  predisposition 
still  exists.  Occasionally,  however,  after  injury  or  abuse  of  an 
organ,  the  reaction  may  involve  related  structures,  the  lesion  pre- 
disposing to  disease  be  corrected  by  natural  forces  alone,  and  com- 
plete recovery  occur. 

In  all  cases  in  which  lesion  conditions  of  any  kind  are  present, 
good  practice  and  common  sense  indicate  that  both  removal  of  the 
lesion  and  of  the  abuse  must  go  hand  in  hand  if  the  most  satisfac- 
tory results  are  to  be  obtained. 


CHAPTER  XXXVII 

OSTEOPATHY  AND  CELL  LIFE 

The  inherent  power  of  the  organism  to  adjust  itself  must,  in 
the  last  analysis,  rest  in  the  power  of  individual  cells  to  act,  not  only 
as  individuals,  but  also  as  units  of  the  organism  as  a  whole. 

"In  multicellular  organisms,  every  cell  must  maintain  its  struc- 
tural integrity  if  it  is  to  maintain  its  normal  function.  Things 
which  affect  the  gross  structure  of  the  body  are  efficient  causes  of 
mal-function  only  as  they  affect  the  structure  or  the  environment 
of  the  cells  of  the  tissues.  This  is  the  reason  why  gross  deform- 
ities so  often  cause  only  slight  mal-function, — the  cells  remain  fairly 
normal  in  structure  and  environment.  For  the  most  part,  however, 
gross  changes  do  affect  cell  structure  and  environment;  it  is  only 
occasionally  that  individual  cells  remain  unaffected  by  deformities.'" 

"Cells  vary  greatly  in  size,  shape  and  micro-chemical  reactions; 
these  structural  variations  are  associated  with  corresponding  func- 
tional activities.  The  cells  of  any  one  tissue  present  certain  simi- 
larities of  structure,  so  that  the  tissue  from  which  any  group  of 
cells  is  taken  may  be  recognized  by  the  characteristics  of  the  cells 
and  their  relationships.  The  substance  of  which  cells  are  composed 
is  so  nearly  alike  that  it  is  all  spoken  of  by  one  term,  being  called 
'■'protoplasm."  Living  protoplasm  can  neither  be  analyzed  nor 
synthesized.  The  very  act  of  analysis  destroys  the  molecule  of  dead 
protoplasm,  to  say  nothing  of  that  which  is  living.  During  life 
there  is  constant  flux;  nourishment  is  constantly  being  taken  in, 
digested,  built  into  living  tissue,  or  built  into  deutoplasmic  mater- 
ial of  extremely  variable  types;  the  molecules  employed  for  storing 
energy  or  food  are  constantly  being  built,  utilized  and  destroyed; 
katabolites  are  constantly  being  produced  and  eliminated,  so  that 
at  no  two  consecutive  instants  of  time  is  any  mass  of  protoplasm 
identical. 

"Now  life  is  something  of  which  we  know  practically  nothing, 
except  as  it  manifests  itself.  It  is  impossible  to  define  life  in  any 
exact  manner.     This  is  also  true  of  every  fundamental  thing;  no 


^Burns:     Basic  Principles. 

166 


OSTEOPATHY  AND  CELL   LIFE  167 

one  can  exactly  define  life,  heat,  force,  matter,  the  elements,  our 
own  minds,  yet  we  all  know  that  these  things  act,  and  how  to  use 
them  in  many  ways.  Herbert  Spencer's  definition  of  life, — "the 
continual  adjustment  of  internal  conditions  to  external  relations" 
is  an  expression  of  this  fact.  Dr.  A.  T.  Still's  definition  presents 
a  similar  view,  "Life  is  an  individualized  Principle  of  Nature."^ 

"In  living  substance,  the  matter  exists  in  the  form  of  a  large 
number  of  very  complex  labile  compounds, — complexes  of  molecules. 
Yerworn  objects  to  the  term  "living  molecule'  as  the  word  molecule 
signifies  a  definite  chemical  compound  of  some  stability,  while  in- 
stability and  change  are  the  essential  characteristics  of  living  sub- 
stance. He  therefore  suggests  the  term  "biogen"  to  designate 
those  exceedingly  complex  compounds  that  are  at  the  focus  of  life 
and  by  means  of  which  vital  phenomena  are  manifested. '  '^ 

Each  of  these  molecules  may  be  considered  as  a  machine  for 
the  performance  of  certain  duties  in  the  life  history  of  the  cell. 
If  these  machines  are  inefficient,  the  duties  involving  upon  them  must 
be  improperly  performed. 

"By  chemistry  the  truths  of  physiology  are  firmly  established 
in  the  mind  of  the  student  of  nature,  that  in  man  a  chemistry  of 
wonderful  powers  does  all  the  work  of  animal  forms,  and  that  in 
the  laboratory  of  nature's  chemistry  is  the  ruling  power.  Thus  in 
chemistry  we  become  acquainted  with  the  law  of  cause  and  change 
in  union,  which  is  a  standard  law  sought  by  the  student  of  oste- 
opathy."^ 

"As  the  result  of  the  peculiarities  of  cell  structure  and  the 
relations  of  its  biogens,  each  cell  and  probably  each  part  of  the  cell 
has  the  power  to  select  just  the  quality  and  quantity  of  each  mater- 
ial from  the  blood  and  lymph  that  it  needs  for  its  nourishment  and 
function. 

This  selective  function,  as  it  is  called,  is  often  affected  in  various 
ways  and  results  in  many  disorders,  When  for  any  reason,  the  nor- 
mal protoplasmic  activity  is  disturbed,  naturally  the  function  of  the 
cell  is  disturbed  and  the  cell  may  be  invaded  by  substances  that  it 
does  not  need,  in  fact  that  it  can  not  make  use  of.     As  a  result 


^Spring,  C.  F,,  The  Cell. 

-Hulett,  C.  M.  T.:    Biological  Basis  of  Osteopathy. 

•''A.  T.  Still:    Research  and  Practice. 


Ib8  PRINCIPLES  OF  OSTEOPATHY 

inert  and  sometimes  harmful  substances  may  be  deposited  within 
or  around  the  cells.  This  is  the  case  in  the  formation  of  gouty 
tophi,  uratic  deposits,  and  the  various  degenerations  and  infiltra- 
tions. On  the  other  hand,  the  cell  may  fail  to  take  up  that  which 
it  ought  and  the  cell  be  poorly  nourished.  These  trophic  disturb- 
ances are  very  numerous  and  are  manifest  by  a  vast  number  of 
symptoms. 

"The  rebuilding  process  of  the  tissue  cells  is  not  very  clearly 
known;  for  just  why  the  cell  selects  certain  elements  and  rejects 
tlie  remainder  is  not  known.  Of  the  organic  foods,  the  proteids 
seem  to  be  the  only  ones  that  enter  into  the  building  up  of  the  cells. 
The  carbohydrates  and  fats  are  the  energy  producers.  The  pro- 
teids, in  the  absence  of  the  fats  and  carbohydrates,  furnish  some 
energy,  so  that  it  is  possible  to  maintain  life  for  an  indefinite  period 
on  proteids  alone;  though  not  at  the  best  advantage. 

"The  selective  function  is  found  not  only  in  the  cell  as  a  whole, 
but  in  the  protoplasmic  molecule  as  well.  "^ 


^Spring,  loc.  cit. 


CHAPTER  XXXVIII 

CELLS  OF  MULTICELLULAR  ORGANISMS 

"It  is  very  necessary  for  the  higher  forms  of  animals  to  be 
composed  of  cells  instead  of  a  single  mass  of  protoplasm  for  three 
reasons.  First,  to  give  form  to  the  body  there  must  be  a  hardened 
tissue  (formed  by  a  certain  kind  of  cells)  to  act  as  support  in  order 
that  the  form  may  be  maintained.  The  nature  of  the  cell  in  this 
tissue  must  be  such  that  it  will  stand  considerable  strain  and  pres- 
sure to  form  a  steadfast  framework.  This  frame  is  covered  and 
rounded  out  with  muscle  and  other  tissue,  and  different  kinds  of 
cell  formation.  Second,  that  the  function  of  the  body  may  be  in- 
creased to  the  highest  state  of  efificiency.  Since  each  part  is  formed 
by  a  certain  kind  of  cell,  organized  to  perform  a  certain  function, 
it  can  do  this  better  than  an  undifferentiated  mass  which  must  do 
all  kinds  of  work  and  therefore  can  do  none  well. 

**  Third,  for  the  sake  of  nutrition.  Small  cells,  bathed  in  nu- 
tritious lymph,  are  easily  and  quickly  fed,  while  their  wastes  are 
easily  and  quickly  removed.  A  large  protoplasmic  mass  with  a 
single  nucleus  fails  in  these  respects.  The  surface  of  any  mass 
varies  according  to  the  square  of  the  diameter;  the  mass  varies  as 
the  cube.  Hence,  the  larger  the  cell,  the  more  disproportionate  is 
the  relation  between  nutrition — providing  surface  and  nutrition — 
demanding  mass. 

"Metabolism  may  be  defined  as  'any  change  produced  in  the 
body  upon  matter  by  living  tissue.'  This  process  is  confined  to  the 
organism,  with  living  tissue  as  the  actor  and  the  matter  acted  upon 
Tcay  be  either  living  or  lifeless  material.  Naturally  then  this  subject 
comprises  many  different  activities  in  the  body, 

"For  the  sake  of  convenience  metabolism  is  divided  into  two 
sub-heads,  anabolism  and  katabolism.  Anabolism  comprises  those 
processes  which  are  constructive  in  nature,  or  building  up;  while 
katabolism  is  the  destructive  process,  or  breaking  down.  These 
are  very  closely  related  and  occur  simultaneously.  Every  movement, 
every  chemical  change,  in  fact  every  manifestation  of  life,  is  evi- 
dence of  metabolic  processes  at  work." 

"The  energetics  of  a  cell  present  themselves  in  various  forms, 
which  may  be  grouped  as  resisting  or  potential  energy  and  as  moving 
or  kinetic  energy.  Among  the  former  we  have  chemical,  osmotic, 
cohesion  and  gravitation  forces,  and  among  the  latter  mechanical 
power,  heat,  light  and  electricity.    But  naturally  this  classification 

^Spring,  loc.  cit.  169 


170  PRINCIPLES  OF  OSTEOPATHY 

is  not  tixed,  because  some  of  these  energies  may  present  themselves 
in  either  form.  The  chemical  energy,  for  example,  remains  potential 
only  so  long  as  the  atoms  retain  their  position  toward  one  another 
and  become  kinetic  as  soon  as  they  arrange  themselves  in  accord- 
ance with  specific  aflfinities.  Thus  the  animal  receives  potential 
chemical  energy  in  the  shape  of  complex  organic  substances  and 
oxygen.  The  regrouping  of  the  former  under  the  iafluence  of 
oxygen  eventually  gives  rise  to  carbon  dioxid,  water  and  simpler 
nitrogenous  bodies  as  well  as  to  a  large  amount  of  actual  (kinetic) 
energy.  Metabolism,  therefore,  is  intended  to  keep  the  organism 
in  energy-equilibrium.  The  chemical  intake  and  outgo  are  balanced 
in  such  a  way  that  the  cells  can  continue  to  furnish  the  energy 
required  of  them.  The  metabolic  equilibrium  and  the  dynamical 
equilibrium  must  in  the  long  run  pursue  a  parallel  course."* 

"The  activities  of  living  organisms  consist  of  responses  to 
stimuli.  A  stimulus  may  be  anything  which  produces  a  change 
in  spontaneous  vital  phenomena.  The  character  and  degree  of  re- 
sponse depends  upon  the  chemical  and  physical  forces  involved  in 
the  constitution  of  the  organism  and  its  relations  to  its  environment. 

■'Typical  living  substance  existing  in  an  ideal  environment,  in 
which  the  conditions  of  vital  phenomena — the  character  of  the  sur- 
rounding medium,  the  food  supply,  moisture,  heat  and  light — were 
exactly  suited  to  its  needs  would  by  reason  of  what  Hering  terms 
"the  internal  self-regulation  of  metabolism"  present  a  condition  of 
cheraico-physical  metabolic  equilibrium.  The  spontaneous  vital  phe- 
nomena would  present  a  uniform  succession  of  events.  But  any 
change  in  the  environment  would  be  followed  by  a  change  in  the 
metabolism  of  the  living  substance,  an  adaptive  adjustment  of  inter- 
nal conditions  to  external  conditions.  Life  being  manifested  only  by 
a  constant  change  of  matter,  the  first  response  would  be  to  the 
presence  of  waste  products  of  metabolism,  which  as  soon  as  separ- 
ated from  the  living  substance  are  foreign  matter,  inimical  to  the 
welfare  of  the  organism.  It,  therefore,  responds  to  their  presence 
by  excretory  action.  "We  may  imagine  that  the  matter  next  to  that 
eliminated  is  now  moved  up  to  take  its  place  and  that  a  succession 
of  such  responses  occurs  throughout  the  series  involved  in  the 
integrity  of  the  living  substance.  At  the  beginning  of  the  series 
there  will  be  a  demand  for  new  material,  which  will  be  shown  by 
the  response  of  the  organism  to  the  presence  of  food.  Thus  the 
maintenance  of  the  equilibrium  of  the  matter  and  energy  of  living 
sn]),stanco  itself  may  be  conceived  as  a  series  of  responses  to  stimuli. 
But  these  we  cannot  segregate  and  study  separately,  as  they  are 
inseparably  bound  up  with  life,  and  remain  or  disappear  with  it. 

'Biirton-Orpitz:      Physiology. 


CHAPTER  XXXIX 

CELL  RESPONSE  TO  STIMULATION 

"Observation  of  changes  in  the  activities  of  the  organism  in 
response  to  changes  in  the  environing  conditions,  has  already  yielded 
to  investigation  much  of  value,  and  is  pregnant  with  promise  of 
much  more.  Davenport  recognizes  eight  agents  that  act  as  stimuli 
on  living  organisms,  viz:  Chemical  substances,  water,  density  of 
the  environing  medium,  molar  agents,  gravity,  electricity,  light, 
heat.  The  effect  of  these,  separate  or  combined,  in  modifying  the 
course  of  spontaneous  vital  phenomena,  constitute  the  field  of 
ceUular  physiology  and  pathology.  It  will  be  seen  that  this  includes 
all  physiological  processes,  when  we  recall  that  the  individual  cell 
of  the  body  may  be  conceived  as  existing  in  an  environment  con- 
sisting of  neighboring  cells  (including  the  nerve  filament  that  may 
supply  it),  water,  chemical  substances  (in  the  blood  and  lymph), 
nutrient  substances,  waste  products,  heat,  and,  in  some  cases,  light; 
and  the  resultant  of  the  variously  combined  effect  of  these  upon 
the  differentiated  and  specialized  forms  of  cell  substance  is  seen 
in  the  different  physiological  functions.  The  action  of  these  cells 
may  be  influenced  by  variations  of  the  heat  of  the  body,  as  in  fevers 
and  inflammation;  by  the  presence  of  nutrient  substances  as  in 
digestion  and  assimilation;  by  the  presence  of  waste  matters,  as  in 
excretion;  by  various  manifold  stimuli  conveyed  to  them  by  the 
nerves ;  and  in  a  thousand  complex  forms  many  of  which  we  cannot 
yet  analyze. 

"The  nature  of  the  response  to  stimuli  is  a  property  of  the 
organism,  not  of  the  stimulus.  The  mechanism  of  the  metabolic 
cycle  precludes  any  effect  of  stimuli  except  in  two  directions,  viz., 
excitation  or  depression.  The  successive  changes  have  a  specific 
order  of  sequence.  Qualitative  change  in  the  cycle  would  mean 
death.  Only  quantitative  change  is  possible.  The  multitude  of 
cycles  which  we  may  imagine  in  progress  at  the  same  time  in  living 
substance,  may  be  changed  in  their  relations  to  each  other.  Some 
may  be  excited,  some  depressed  and  some  stopped  altogether.  The 
infinite  variety  thus  made  possible  justifies  the  supposition  that 

171 


172  PRINCIPLES  OF  OSTEOPATHY 

the  protoplasm  in  any  individual  may  never  twice  be  the  same  in 
structure.  Protoplasm,  therefore,  is  not  to  be  regarded  as  a  chem- 
ical, but  a  morphological  concept. 

"An  important  factor  in  the  functioning  of  cells  in  a  multicellular 
organism,  is  that  the  component  cells,  no  matter  how  widely  differ- 
entiated, morphologically  and  physiologically,  have  their  limits  of 
capacity  for  response  approximately  in  the  same  plane;  otherwise 
there  would  bo  no  such  thing  as  co-ordination  of  function.  This 
plane  varies  as  between  different  individuals  and  in  the  same  indi- 
vidual at  different  times.  These  considerations  explain  the  varying 
effect  of  drugs  upon  different  persons,  or  upon  the  same  person  at 
different  times,  and  it  also  explains  why  drug  medication  can  never 
bo  reduced  to  an  exact  science. 

"We  have  seen  that  protoplasm  is  a  'highly  irritable  automatic- 
ally adjustable  substance,'  and  that  the  cells  in  a  human  body  re- 
spond to  the  stimuli  of  varying  external  conditions  in  an  adaptive 
way,  not  only  with  reference  to  the  cell  itself,  but  also  to  that  of 
the  whole  body,  and  we  are  now  prepared  to  inquire  into  the  abnor- 
mal conditions  constituting  disease. 

"Disease  may  consist  in  a  disturbance  of  the  metabolic  cycle, 
as  in  the  various  degenerations,  or  it  may  be  due  to  failure  of  the 
normal  response. 

The  statement  may  be  ventured  that  all  disease  may  be  ascribed 
to  a  failure  of  protoplasm  to  respond;  first  to  the  stimulus  of  its 
own  internal  vital  phenomena,  resulting  in  an  interruption  of  the 
metabolic  cycle — disturbed  nutrition ;  and  second,  to  the  stimulus 
of  abnormality  in  its  environment — pathological  products  and  bac- 
teria— resulting  in  neoplasms,  autointoxications  and  infections;  and 
such  failure  to  respond  when  continued  can  eventuate  only  in  death. 

"Extraneous  stimulation  is  not  necessary;  but  if  the  capacity 
tor  response  still  remains,  we  will  have  this  condition:  Pathologic 
substances,  by  their  presence  in  the  organism  act  as  stimuli  at  two 
points ;  first,  at  the  point  of  initiation  of  the  abnormal  process  there 
may  be  such  reaction  to  their  presence  as  tends  to  restore  normal 
metabolic  conditions  by  overcoming  the  cause  of  stoppage  or  irri- 
tation, as  in  'self-limited'  diesases;  second,  the  mechanism  of  elim- 
ination reacts  to  their  presence  by  increased  excretory  processes 
to  get  rid  of  the  products  of  stoppage  or  irritation.  If  the  condi- 
tions are  right  these  reactions  take  place  if  need  be  to  the  full  limit 


CELL  RESPONSE  TO   STIMULATION  173 

of  the  reacting  power  of  the  cells  exhibiting  them.  In  other  words, 
the  cure  of  disease  requires  the  presence  of  no  other  stimulus  than 
that  of  its  own  products.  The  application  of  any  extraneous  stimulus 
in  the  form  of  drugs,  electricity,  heat,  water,  what  not — ^with  the 
idea  of  revitalizing  or  reforming  in  any  direct  way,  the  metabolic 
cycle,  is  not  only  futile,  but  wholly  superfluous,  and  'adding  insult 
to  injury. '  Nature  neither  needs  nor  can  use  any  assistance  in  her 
work.  What  nature  does  need  and  what  we  may  do  is  to  maintain 
suitable  external  conditions.  Therapeutics  then  has  only  to  do  with 
the  elements  of  the  environment  in  which  nature  works.  In  this 
sense  antidotes  to  poisons  are  necessary;  heat  may  be  applied  to 
chilled  tissues,  and  water  may  serve  as  a  food  element,  or  for 
cleansing,  externally  and  internally. 

"If  living  substance  responds  to  abnormalities  in  such  a  way 
as  to  bring  about  their  correction,  disease  ought  always  to  be  cured 
spontaneously;  indeed,  it  ought  to  be  wholly  prevented.  That  it 
does  so  respond  is  seen  in  the  constant  elimination  of  waste  pro- 
ducts of  metabolism ;  and  that  there  is  sometimes  a  failure  in  spon- 
taneous removal  of  abnormalities  may  be  due  to  one  or  both  of 
two  conditions;  to  exhaustion  of  the  power  of  response,  or  to  inter- 
ference with  its  manifestation.  The  first  is  illustrated  systemically 
in  the  effects  of  starvation,  overwork,  excessive  use  of  drugs,  alcohol, 
etc.  The  second  is  the  basis  of  osteopathic  practice  and  requires 
some  examination  of  the  mechanics  of  vital  processes. 

"The  relations  of  the  metabolic  cycle  to  the  conditions  of  its 
expression  are  very  aptly  illustrated  by  Davenport,  who  compares 
the  protoplasmic  mass  to  a  factory,  with  many  boilers  and  engines, 
much  shafting  and  belting,  and  countless  machines  doing  the  most 
varied  work.  The  amount  of  energy  developed  in  the  boilers  and 
the  efficiency  of  the  engines  and  machines  varies  with  certain  con- 
ditions, such  as  the  amount  of  heat  applied  to  the  former,  and  the 
friction  and  waste  in  the  latter.  The  limiting  mechanical  condi- 
tions are  reached  when  the  boiler  is  rent  by  the  steam  pressure, 
a  breakdown  is  caused  by  friction  or  a  part  rusts  through  and 
crumbles  away.  The  limiting  dynamical  conditions  are  reached 
when  the  heat  no  longer  suffices  to  force  steam  in  the  boiler,  or  the 
power  is  insufficient  to  run  the  machine.  In  either  case  at  the 
structural  or  the  dynamical  limit,  work  ceases.  In  protoplasm  the 
structural  limiting  conditions  are  of  two  main  sorts — ^mechanical, 


174  PRINCIPLES  OF  OSTEOPATHY 

in  which  the  gross  structure  becomes  broken  down,  as  in  drying  or 
freezing;  and  chemical,  in  which  the  composition  becomes  changed 
as  in  the  effect  of  poisons,  high  temperature,  strong  electric  current, 
etc.  The  dynamical  limiting  conditions  are  the  absence  of  oxygen 
or  other  food  stuffs,  the  absence  of  water  necessary  to  the  solution 
and  circulation  of  the  food,  and  too  low  a  temperature.  "Thus 
the  conditions  essential  to  metabolism  are  the  absence  of  causes 
mechanically  rupturing  the  machine,  the  absence  of  agents  of  such 
intense  activity  as  to  change  profoundly  its  molecular  constitution, 
and  the  presence  of  those  agents — food,  heat,  light  and  water — 
which  supply  or  distribute  the  energy  of  metabolism.  Given  proto- 
plasm under  these  conditions,  and  normal  metabolism  must  occur; 
without  them  there  is  no  metabolism,'  Surely  if  such  a  figure  cor- 
rectly illustrates  the  conditions  in  a  bit  of  apparently  homogeneous 
jelly-like  protoplasm,  it  is  not  inappropriate  when  applied  to  so 
complex  a  structure  as  the  human  body! 

"Physical  conditions  are  our  only  field  of  intervention.  We  have 
seen  that  equilibrium  in  the  ingestion  and  output  of  substances — 
normal  continuity  of  the  metabolic  cycle — by  the  cell  is  the  essential 
internal  condition  of  the  integrity  of  the  vital  processes.  This  equi- 
librium is  always  maintained  by  reaction  of  the  cell  to  changes  in 
its  environment  to  the  full  limit  of  its  reacting  power.  In  order 
that  this  power  of  reaction  shall  be  normally  expressed,  it  is  neces- 
sary that  the  physical  conditions  of  the  cell  substance  shall  be  nor- 
mal. We  are  barred  from  any  direct  participation  in  the  vital 
processes  so  far  considered.  We  cannot  interpose  upon  the  organism 
an  exercise  or  condition  not  required  by  the  laws  of  its  economy. 
Our  field  of  intervention  must  lie  in  the  physical  relations  existing 
in  the  organism.    Let  us  examine  these  conditions. 

"The  size  of  the  cell  is  one  of  these  conditions.  By  the  operation 
of  certain  mathematical  laws  of  growth  concerning  the  relation  of 
surface  to  mass,  the  single  cell  is  kept  very  small,  so  that  a  close 
relation  between  the  cell  and  the  surrounding  medium  is  possible, 
in  plants  where  air  is  the  medium,  exposure  is  secured  by  extensive 
external  branching.  In  animals  where  the  medium  is  liquid,  expos- 
ure is  secured  by  extensive  circulatory  channels.  Its  bearing  on  the 
mechanics  of  nutrition  is  the  only  reason  for  referring  to  this, 

"Another  condition  is  the  movement  of  protoplasm  within  the 
cell,  a  characteristic  clearly  shown  in  low  forms  of  life,  in  which 


CELL   RESPONSE   TO   STIMULATION  175 

constant  currents  in  the  cell  substance  are  found.  In  the  hair-like 
pseudopodia,  which  many  of  these  organisms  throw  out,  outflowing 
and  return  currents  are  to  be  seen.  Even  when  these  pseudopodia 
themselves  are  so  slender  as  to  be  almost  to  the  limit  of  visibility 
under  the  microscope,  these  currents  have  still  been  demonstrated. 
Similar  movements  in  cell  substance  either  en  masse  or  of  a  fluid 
portion  through  the  interstices  of  a  recticulum  occur  in  the  human 
body  in  the  cells  of  glands,  epithelium,  muscles,  nerves,  in  the  blood, 
and  possibly  others.  These  movements  aside  from  their  specific 
relation  to  the  special  function  of  the  cell,  are  necessary  to  the 
ingestion  of  nutrient  material,  the  exchange  of  material  between 
different  parts  of  the  cell,  and  the  egestion  of  waste  products. 

"Perhaps  the  most  important  physical  property  of  the  cell  is 
that  of  contractility,  a  property  that  is  characteristic  of  protoplasm, 
and  although  the  complex  requirements  of  such  an  organism  as  the 
human  body  have  resulted  in  highly  specialized  cells  for  certain 
properties,  yet  these  cells  have  lost  none  of  the  fundamental  prop- 
erties of  protoplasm.  For  instance,  muscle  cells,  differentiated  for 
contraction,  still  exhibit  irritability  and  secretion.  Gland  cells 
differentiated  for  secretion  are  still  irritable  and  contractile.  Nerve 
cells  differentiated  for  irritability  still  secrete  as  required  by  their 
own  metabolism,  and  retain  contractility  as  shown  in  the  contraction 
and  ameboid  movements  of  ganglion  cells  in  the  lengthening  and 
shortening  of  their  dendrites.  .  .  .  The  conclusion  is  forced  upon 
us  that  the  conditions  of  mechanical  stress  in  the  cell  structure  and 
in  the  tissues,  varying  in  degree  and  in  time,  the  result  of  chemical, 
thermal  or  other  stimuli,  acting  either  directly  or  as  mediated  by 
disturbed  nerve  mechanisms,  are  important  factors  in  the  problem 
of  the  causation  of  disease. 

'Somewhat  different  in  character  and  scope,  but  yet  intimately 
related  to  cell-activities,  is  the  effect  of  nerve  stimuli.  In  all  the 
higher  vertebrates  and  especially  in  man  the  predominating  influence 
of  the  nerve  is  almost  absolute.  So  dependent  are  the  other  tissue 
cells  upon  this  form  of  stimulus  that  in  its  absence  spontaneous 
action  is  lost  or  sinks  to  the  lowest  point.  A  normal  skeletal  mus- 
cle never  contracts  except  it  is  stimulated,  and  if  its  nerve  supply  is 
wholly  lost,  its  metabolism  sinks  to  so  low  an  ebb  that  it  degenerates 
by  atrophy.  Gland  cells  are  another  example  of  this  dependence, 
and  even  in  the  nervous  system  itself  there  is  often  an  interdepend- 


176  PRINCIPLES  OF  OSTEOPATHY 

ence  between  ganglion  cells.  .  .  .  The  direct  effect  of  nerve 
stimuli  upon  processes  of  metabolism;  upon  the  processes  of  secre- 
tion and  excretion,  as  in  gland  cells,  and  in  the  regulation  of  the 
conditions  of  stress — tone — in  all  contractile  tissue,  both  intra-  and 
extra-cellular,  show  the  importance  of  the  part  they  play  in  co- 
ordinating the  innumerable  activities  in  so  complex  an  organism 
as  the  human  body.  The  contractility  of  dendrites  is  an  important 
point,  considered  in  connection  with  the  statement  that  the  relation 
between  the  dendrites  of  one  nerve  and  the  axone  of  another  is 
that  of  contiguity  but  not  continuity,  as  it  explains  how  nerve  cur- 
rents may  be  switched.'" 

The  function  of  the  nervous  system  is  to  unify  diverse  structures, 
—in  normal  and  abnormal  conditions;  in  time,  and  in  inheritance. 
During  normal  activity  of  normal  brains,  this  important  part  of 
the  nervous  system  unifies  individuals  and  races  in  their  civilized 
activities. 

The  osteopathic  view  of  the  cell,  whether  as  a  unit  or  as  one 
of  the  millions  making  up  the  human  body,  is  largely  covered  by 
the  following  statements: — 

Normal  structure  is  essential  to  normal  function. 

Normal  function  is  essential  if  normal  structure  is  to  be  main- 
tained. 

Normal  environment  is  essential  to  normal  function  and  struc- 
ture, though  some  degree  of  adaptation  is  possible  for  a  time,  even 
under  abnormal  conditions. 

In  the  human  body,  with  its  diversified  functions,  we  may  add 
also, — 

The  blood  preserves  and  defends  the  cells  of  the  body. 

The  nervous  system  unifies  the  body  in  its  activities. 

Disease  symptoms  are  due  either  to  failure  of  the  organism  to 
meet  adverse  circumstances  efficiently,  or  to  structural  abnormali- 
ties. 

Rational  methods  of  treatment  are  based  upon  an  attempt  to 
provide  normal  nutrition,  innervation  and  drainage  to  all  tissues 
of  the  body,  and  these  depend  chiefly  upon  the  maintenance  of 
normal  structural  relations. 

'Hulett,   C.   M.   T.,   loc.   cit. 


Authorities  Consulted 

(References   to    other  authors   in   general   index) 


A.  T.  STILL  EESEABCH  INSTITUTE,  Bulletins  and  Reports. 

ATZEN,  C.  B.,  D.  O.,  ref.  22. 

BOOTH,  E,  R.,  D,  O,,  History  of  Osteopathy;  various  papers. 

BURTON-OPITZ,  E.,  Physiology. 

DAVENPORT,  ref.  173. 

DEASON,  J.,  D.  0.,  Physiology;  various  papers. 

HEAD,  ref.  120. 

HULETT,  C.  M.  T.,  D.  O.,  ref.  54;  166  et  seq. 

KARSNER  AND  ECKER,  ref.  103. 

MAC  CALLUM,  W.  G.,   Pathology. 

MACLEOD,  J.  J.  R.,  Physiology  and  Biehemistry. 

M'CONNELL,    C.    P.,    D.    0.,    Practice    of    Osteopathy;    Clinical    Osteopathy; 
various  papers. 

MILLARD,  F.  P.,  D.  O.,  Lymphatics. 

SCUDDER,   ref.   82. 

SLOSSON,  JANE,   D.  O.,   ref.   62. 

SPENCER,  HERBERT,  Principles  of  Biology. 

SPRING,  C.  F.,  D.  O.,  The  Cell,  ref.  167  et  seq. 

STARLING,   E.    H.,    Physiology. 

STILL,    A.    T.,   Autobiography;    Philosophy    of    Osteopathy;    Philosophy    and 
Mechanical  Principles  of  Osteopathy;   Research  and  Practice. 

TASKER,  D.  L.,  D.  O.,  Principles   of  Osteopathy;  various  papers. 

WELLS,  Chemical  Pathology. 

WHITING,  C.  A.,  ref.  95. 

WILSON,  The  Cell  in  Development  and  Inheritance. 

177 


Index 


Abbott 102 

Abnormal   Structure   70 

Abuse  cause  of  disease 

74,  92  et  seq.  165 

in  intensity  93 

in  time  92 

of  function   92  et  seq. 

Adaptation   68,  75,  88 

Adhesions  84 

Adjustive  mechanics  41 

Adjustment    88 

constant   24 

in  disease  61 

in   health   60 

in  starvation  62 

in   structural   relations 63 

meclianical  41 

methods   of   133 

of  muscular  lesions 136 

of  osseous  lesions 133  et  seq. 

Ami)litude  of  muscular  action 124 

Anabolism    169 

Ancient   practices    14 

Anorexia  108 

Antibodies   105 

Antitoxins   105 

Approximation,  in  relaxation 140 

Art    of   Osteopathy 12 

Attitude,  in  lesions 116 

Atwater    57 

Auscultation    113 

Bacteria,  constitutional  effects 99 

local  effects  99 

not  sole  cause  of  disease 102 

pathojifcnic   98 

protection  against 104 

saprophytic    98 

Balance  of  energy 49 

Bichat  ". 17 

Body  as  chemical  laboratory 

-"- 38,  44   et  seq. 

as  machine  37  et  seq. 

energy  of  43 

fuel   of   52 

unity   of  29 

Borelli  16 

Causes   of  disease 33  et  seq.,  95  et  seq. 

of  lesions  78 

Cell   doctrine 26,  33 

life  166 

response    171 

Colls  of  multicellular  organisms 169 


Change,  constant  in  life 24 

Chemical  action  in  body 38,    44 

Church    70 

Circulation  35 

Classes  of  lesion  , 77 

Colleges,    osteopathic    6 

Color,  in  lesioned  areas 125 

Connective  tissue  lesions 142 

Contractions  123  et  seq. 

Contracture   123 

Corrective   treatments   130 

Definitions  22 

Descartes   16 

Diagnosis,  instruments  in 114 

of  disease 107  et  seq. 

of  lesions 115  et  seq. 

Diarrhea,   a  useful   symptom 108 

Diet   52,     56 

Dietetic  habits  58 

direct  control 153  et  seq. 

Disease,  adjustment  in 61 

cause  of 33,    95 

caused  by  abuse 74,     93 

caused  by  environment 74 

caused  by  germs 98  et  seq. 

caused  by  lesions 86  et  seq. 

diagnosis  of  107  et  seq. 

etiology  of  70  et  seq. 

maintained  by  structure 74  et  seq. 

not  due  to  bacteria  alone 102 

predisposing  and  exciting  causes..  95 

structural  causes  of 35 

symptoms  of 107  et  seq. 

treatment  of  164 

Drugs 18 

Effects  of  lesions 88  et  seq.,  116,  123 

Electricity  48 

Energetics  of  cell 169 

Energy,  balance  49 

nature  of  43 

of  body 43  et  seq. 

Environment,  cause  of  disease 74 

Etiology  of  disease 70  et  seq. 

Evolution   and   revolution 14 

Exaggeration  of  lesions 133 

Exciting  causes  of  disease 95 

Fever,  a  useful  symptom 107 

Frequency  of  treating 146 

Friction    46 

Fuel  of  body 52 

Function,  abuse  of 92  et  seq. 


178 


INDEX 


179 


Function  and  structure 25  et  seq. 

Functions,  perverted,  in  lesions 116 

Galen  15 

Galvani  17 

Germ  theory  of  disease. 17,  98  et  seq. 

Glisson    17 

Glycosuria    1 09 

Goltz   155 

Gravitation    45 

Gross  lesions  70 

Habits,   dietetic  58 

Hahneman   18 

Haller   17 

Harvey   16 

Health,  adjustment  in 60 

Heat    46 

Hebrews,   in   sanitation 14 

Hemoglobin  40 

Heredity  66 

Hilton   18, 121 

Hippocrates  14 

History  of  Medical  Practice— .14  et  seq. 

Hypersensitive   areas   122 

latro-chemical  school  16,     17 

Idiosyncrasy    57 

Immunity  .100  et  seq. 

acquired   101 

individual  101 

inherited  101 

passive    101 

racial  100 

species  100 

structural  1 00 

varieties  of 100 

Inflammation  a  useful  symptom 

105,    110 

Inhibition  and  stimulation 

150,  et  seq.  161 

Instruments    for    diagnosis 114 

Internal  causes  of  lesions 80 

Iron  in  body 40 

Irritability  of  tissues 90 

Katabolism    169 

Klebs  ; 18 

Koch   18 

Krukenburg  18 

Ladd    20 

Landmarks,  use   of 117 

Length    of   treatments 147 

Lesion  70,  77  et  seq. 

adjustment  of  133 

attitude    in    116 

cause  of  disease 86  et  seq. 

cause  of  pain 119  et  seq. 

causes  of  78  et  seq. 

classified  77 

connective  tissue  142 

diagnosis  of 115  et  seq. 

effects   of 88  et  seq. 


exaggeration   of 133 

examination  of 115 

in   prophylaxis   129 

maintenance  of 82  et  seq. 

mechanical   origin   of 79 

muscular  changes 123  et  seq. 

pathology  of  83 

reflex  effects  of 90 

sensory  perversions  in 117 

symptoms  of  89 

thermal  origins  of 79 

Life,  nature  of 23 

Light  47 

Ling  18 

Lusk    57 

Machine,   living 37,  60 

Maintenance  of  lesion 82  et  seq. 

Marey  16,    25 

Materialism  23 

Mechanical  causes  of  lesions 79 

Mechanics,  nature  of  body 37  et  seq. 

principles  in  body —.37,  60 

Medical  practice,  history  of....l4  et  seq. 

Metabolism 34,     54 

Mensuration    113 

Methods   148 

of  adjustments  133 

of  examination  112  et  seq. 

of  relaxation  138 

of  treating  148 

Middle  Ages  16 

Modern  times 17 

Molecular  relations  45 

Multicellular  organism,  cells  of 169 

Muscle,  rigor  of 124 

Muscular  changes  in  lesioned  areas.— 

123  et  seq. 

Muscular  lesions,  adjustment  of 136 

Nancrede    71, 102 

Nerve  energy  49 

structures  153 

Normal,  defined  65 

tendency  to  65 

Objective  symptoms  Ill 

Opsonins  104 

Osseous  lesions,  adjustment  of 133 

Osteopathy  and  eeU  life 166  et  seq. 

art  of  12 

basis   of   11 

definitions   20   et  seq. 

philosophy  of   13 

science  of  12 

vs.  other  systems 150 

Osteopathic  Colleges  6 

Pain,  anatomical  relations  of 120 

central  origin  121 

in  lesioned  areas 118  et  seq. 

referred     119 


180 


INDEX 


Palatability  57 

Palliative  treatment  130,  131 

Palpation  112 

Paracelsus    16 

Park    18 

Pasteur  18 

Pathogenesis  of  lesion 86 

Pathogenic    organisms    98 

Pathology  of  lesion 83 

Percussion    113 

Perversions  in  function 94, 116 

Pfluger    54 

Phagocj-tosis   104 

Philosophy  of  Osteopathy 13 

Photic  energy  47 

Physical  state  of  organisms 174 

Predisposing  causes  of  disease 95 

Pressure,  in  adjustment 134 

in  pathogenesis  of  lesion 86 

in  relaxation 139 

Priestly  17 

Prophylaxis   127, 129 

Protection  against  bacteria... .104  et  seq. 

Proteid    requirements 57 

Proteids    53 

Protoplasm  23, 166 

Ptomaines  99 

Recovery  75 

Referred  pain 119 

Reflex  effects  of  lesions 90 

Relaxation  136 

Reserves  55 

Respiratory    increase,    a    useful 

symptom  109 

Revolution,  the 20  et  seq. 

Rigor,   muscular 124 

Rotation,   in   adjustment 134 

Sanitation,   Hebrews' 14 

Saprophytic  organisms 98 

Science  of  osteopathy 12 

Scudder  82 

Selective  action 55 

Self-regulation 74 

Self-sufficient    machine 60  et  seq. 

Sensory  perversions  in  lesioned  areas 

117 

Similars,  law  of 18 

Specialization,  need  of 30 

Spencer,  Herbert 24 

Starvation,  adjustment  in 62 

Stimulation    157, 171 


Stimulation  and  inhibition 

150  et  seq.,  161 

Stimuli    34, 171 

Stretching  of  muscles 139 

Structural  causes  of  disease 35 

relations,   self-adjustment  of 63 

Structure,    abnormal 35,  70 

and  function 25  et  seq. 

maintaining    disease 74  et  seq. 

Strumpell  71 

Subjective    symptoms Ill 

Sylvius   17 

Symptoms,    anorexia 108 

diarrhea   108 

fever  107 

glycosuria 109 

inflammation  110 

objective    Ill 

of  disease 107 

of  lesions 89 

respiratory  increase 109 

subjective  Ill 

vomiting  108 

Sydenham  17 

Syncytium    30 

Table,  energy  balance 49 

Temperature  change,  in  lesions 125 

Tendency  to  normal 65 

Tender  areas 122 

Therapeutics   127 

Thermal  causes  of  lesions 79 

Time  of  treating 144  et  seq. 

Toxemia  33 

Treatment,  corrective  vs.  palliative..l30 

frequencv  of 146 

length    of 147 

of  disease 127  et  seq.,  164 

of  disease  caused  by  abuse..l64  et  seq. 

of  other  lesions 142  et  seq. 

palliative    130 

time   required 144 

Tumors   142 

Unity  of  body 29 

Use  and  abuse  of  direct  control 

.>157  et  seq. 

Van   Helmont 16 

Variations    67 

Verworn 33 

Virchow  18,  71 

Vomiting,  a  useful  symptom 108 

Water   53 


Date  Due 

' 

PBiNTED   IN 

U.S.A.             CAT 

NO.   24    161 

1 

A  000  510  225 


f 


WB9^0 
H912t 
1922 

Hulett,  Guy  D. 

Text  book  of  the  principles  of 
osteopathy 


WB9^0 
H912t 
1922 
Hulett,  G.iy  D. 

Text  hoftk  of  the  principles  of  osteopa 

tlpy 

MEDICAL  SCIENCES  LIBRARY 
UNIVERSITY  OF  CALIFORNIA,  IRVINE  \ 

IRVINE,  CALIFORNIA  92664  ' 


